Antenatal Prediction of Neonatal Survival in Sacrococcygeal Teratoma

J Ultrasound Med. 2018 Aug;37(8):2003-2009. doi: 10.1002/jum.14553. Epub 2018 Feb 5.

Abstract

Objectives: In sacrococcygeal teratoma, the presence of high-output cardiac failure resulting from arteriovenous shunting through the large tumor has been associated with an adverse outcome. The objective of this study was to determine whether the tumor size and cardiac biomarkers in cord blood can predict neonatal survival in sacrococcygeal teratoma.

Methods: The study population consisted of 25 neonates with sacrococcygeal teratoma. Tumor size was calculated by the ellipsoid formula using dimensions measured by antenatal ultrasound ([length × width × depth in cm] × 0.52= volume in cm3 ). To adjust the gestational age, the tumor volume index (tumor volume/biparietal diameter) was adopted in the analysis. Cardiac biomarkers for heart failure (N-terminal pro-B-type natriuretic peptide [NT-pro-BNP] and cardiac troponin T [cTnT]) were measured in cord blood taken at the time of delivery.

Results: The rate of neonatal death was 24% (6 of 25). The cases that resulted in neonatal death had a higher tumor volume index and higher concentrations of NT-pro-BNP and cTnT than those with survival. A tumor volume index of greater than 60 cm3 /cm, elevated NT-pro-BNP (>2000 pg/mL), and elevated cTnT (>0.08 ng/mL) had sensitivity of 100% for prediction of neonatal death.

Conclusions: The tumor volume index and cord blood biomarkers for heart failure can be promising prognostic markers for neonatal survival in sacrococcygeal teratoma.

Keywords: N-terminal pro-B-type natriuretic peptide; biochemical markers; cardiac troponin T; fetal cardiac function; obstetrics (detailed fetal anatomy); sacrococcygeal teratoma; tumor volume.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Fetal Blood
  • Humans
  • Infant, Newborn
  • Male
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Perinatal Death*
  • Predictive Value of Tests
  • Pregnancy
  • Sacrococcygeal Region / diagnostic imaging
  • Sacrococcygeal Region / pathology
  • Sensitivity and Specificity
  • Survival Analysis
  • Teratoma / blood*
  • Teratoma / diagnostic imaging*
  • Teratoma / pathology
  • Troponin T / blood
  • Tumor Burden
  • Ultrasonography, Prenatal / methods*
  • Young Adult

Substances

  • Biomarkers
  • Peptide Fragments
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain