Ultrasound Obstet Gynecol

. 2023 Jan 27.

 doi: 10.1002/uog.26164. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36704940/

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta-analysis

Y Chen ^# 1, R Xu ^# 1, X Xie ^# 1, T Wang ¹, Z Yang ², J Chen ¹

Affiliations expand

• PMID: 36704940
• DOI: 10.1002/uog.26164

Abstract

Objective: It is debated whether fetal endoscopic tracheal occlusion (FETO) is beneficial to fetuses with congenital diaphragmatic hernia (CDH), and whether FETO has different effects in moderate and severe CDH. We conducted an updated meta-analysis to assess the overall effects of FETO on clinical outcomes of CDH.

Methods: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database to retrieve eligible studies published before September 8^th , 2022 regardless of study designs and languages. Studies were included if CDH fetuses underwent FETO surgery against expectant management with at least one outcome reported. The primary outcomes were mortality at 1, 6, 12 months-after-birth, rates of pulmonary hypertension (PH), extracorporeal membrane oxygenation (ECMO) usage and prematurity. Meta-analysis was conducted with odds ratios and mean differences. The quality of included studies and pooled evidence were also assessed.

Results: A total of 1208 CDH fetuses from 20 studies were included in the quantitative synthesis. FETO significantly reduced CDH mortality at 1 and 6 months after birth (OR=0.56, 95%CI=0.34-0.93, P=0.02, NNT=7.67 and OR=0.34, 95%CI=0.18-0.65, P=0.0009, NNT=5.26 respectively, “moderate”/”low” quality evidence). Further subgroup analysis suggested that the improved effects of FETO on the rates of PH and ECMO usage were particularly significant in severe CDH (“moderate” quality evidence), but not in moderate CDH (“low” quality evidence). FETO also induced prelabor rupture of membranes<37 weeks and preterm birth<37 weeks (OR=4.94, 95%CI=2.25-10.88, P<0.0001, NNH=3.13 and OR=5.24, 95%CI=3.33-8.23, P<0.00001, NNH=2.79 respectively) regardless severe and moderate CDH (“high”/”moderate” quality evidence). However, FETO did not induce severe complications, including preterm birth<32 weeks, abruptio placentae or chorioamnionitis (“low” quality evidence).

Conclusion: FETO reduces mortality, rates of PH and ECMO usage in severe CDH, while it reduces only mortality in moderate CDH. Although FETO increases late-prematurity overall, it does not induce extreme prematurity. This article is protected by copyright. All rights reserved.

Keywords: Congenital diaphragmatic hernia; extracorporeal membrane oxygenation; fetal endoscopic tracheal occlusion; mortality; prelabor rupture of membranes; preterm birth; pulmonary hypertension.

This article is protected by copyright. All rights reserved.