Front Pediatr

. 2020 Aug 25;8:467. doi: 10.3389/fped.2020.00467. eCollection 2020. https://pubmed.ncbi.nlm.nih.gov/32984201/

Is Fetal Endoscopic Tracheal Occlusion (FETO) a Predisposing Factor for Acid Gastro-Esophageal Reflux in Infants With Congenital Diaphragmatic Hernia?

Francesco Macchini ¹, Anna Morandi ¹, Stefano Mazzoleni ¹, Martina Ichino ¹, Giacomo Cavallaro ², Genny Raffaeli ^2 3, Carlo Ferrari ¹, Silvana Gangi ², Fabio Mosca ^2 3, Isabella Fabietti ⁴, Nicola Persico ⁴, Ernesto Leva ^1 3Affiliations expand

• PMID: 32984201
• PMCID: PMC7477307
• DOI: 10.3389/fped.2020.00467

Free PMC article

Abstract

Introduction: Various anatomical defects predispose patients with congenital diaphragmatic hernia (CDH) to develop gastroesophageal reflux disease (GERD). The fetal endoscopic tracheal occlusion (FETO) has increased the survival of patients with severe CDHs. The aim of this study was to study GERD in patients who underwent FETO. Materials and Methods: We included patients with CDH treated with or without FETO (“FETO” and “no-FETO” group, respectively) from 2013 to 2016. Data on gestational age (GA), birth weight (BW), initial observed/expected lung to head ratio (O/E LHR), final O/E LHR, duration of ventilation and hospitalization, maximal tracheal diameter, and pulmonary volume were collected. All patients underwent pH-metry after 1 year of life, and the results were compared between groups and correlated to risk factors. Results: Thirty-two patients were included in the study: 10 FETO and 22 no-FETO. No significant differences were observed in the pH-metric results of the two groups. No correlation was found between GA, BW, initial O/E LHR, maximal tracheal diameter, pulmonary volume, and pH-metric results. pH-metric results were correlated with the total duration of ventilation (R = 0.5, p = 0.003) and of hospitalization (R = 0.54, p = 0.001). Gastric herniation is associated with the worse pH-metric result. Conclusions: The FETO procedure does not seem to represent an independent risk factor for GERD. However, patients with the most severe CDH have the worst GERD.

Keywords: congenital diaphragmatic hernia; fetal therapy; gastro-esophageal reflux; neonatal surgery; pH-metry.

Copyright © 2020 Macchini, Morandi, Mazzoleni, Ichino, Cavallaro, Raffaeli, Ferrari, Gangi, Mosca, Fabietti, Persico and Leva.