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F101Evaluation of a new and noninvasive method for determination of fetal lung maturity and risk to RDS

2000; Wiley; Volume: 16; Issue: s1 Linguagem: Inglês

10.1046/j.1469-0705.2000.00015-1-100.x

1469-0705

Ermelando V. Cosmi, R. La Torre, Juan Piazze,

Cleft Lip and Palate Research

Based on our observations in humans ( AJOG 1999; 180:s86) that fetal breathing movements (FBMS) are associated progressively with nasal fluid flow velocity waveforms (NFFVW) as the fetus matures, we now assess this phenomenon relative to the development of neonatal RDS. In effect, we present the possibility that evaluation of FBMS by M‐mode US with simultaneous determination of NFFVW by Doppler flow analysis, may permit diagnosis of fetal lung maturity (FLM) and, thus, risk to NRDS by rapid and reliable noninvasive methods. To the purpose of the study, the FBMS and the NFFVW data were compared with conventional data from amniotic fluid (AF). 39 high‐risk pregnancies were enrolled; all babies were delivered by CS within a week. Each fetus was surveyed for 30 min for thoracic movements (TM), indicative of regular FBMS, by M‐mode and at the same time for NFFVW. Amniocentesis was then performed. The AF sample was analyzed for L/S, lamellar bodies and presence of PG. Of the 39 pregnancies studied, 25 of the neonates had no RDS. Of the latter, only 3 registered no FBMS and NFFVW in utero; they also failed each of the AF tests, while 2 registered only FBMS and equivocal AF tests. 14 neonates developed RDS and none registered NFFVW in utero and each failed the AF tests for FLM. Only 2 of the RDS group had no FBMS. The study indicates that the presence of both FBMS and NFFVW indicates no risk to RDS. Absence of NFFVW, with or without FBMS, has the opposite connotation. The diagnostic accuracy of the noninvasive tests was: sensitivity, 100%; NPV (‘no‐RDS’), 100%; specificity, 80% and PPV (‘RDS’), 73%. The results strongly encourage further evaluation of the noninvasive methods as reliable approaches for evaluating FLM, particularly in cases where af sampling is undesirable or impossible (Supported by EURAIL, Europe Against Immature Lung).