J Pediatr Surg
. 2022 Oct 14;S0022-3468(22)00634-0.
doi: 10.1016/j.jpedsurg.2022.09.042. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36333128/
Morbidity in children after fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: Results from a multidisciplinary clinic
Shelby R Sferra 1, Melanie K Nies 2, Jena L Miller 3, Alejandro V Garcia 1, Erica I Hodgman 1, Annalise B Penikis 1, Abigail J Engwall-Gill 1, Vera Joanna Burton 4, Jessica L Rice 5, Peter J Mogayzel 5, Ahmet A Baschat 3, Shaun M Kunisaki 6
- PMID: 36333128
- DOI: 10.1016/j.jpedsurg.2022.09.042
Background: Although fetoscopic endoluminal tracheal occlusion (FETO) was recently shown to improve survival in a multicenter, randomized trial of severe congenital diaphragmatic hernia (CDH), morbidity outcomes remain essentially unknown. The purpose of this study was to assess long-term outcomes in children with severe CDH who underwent FETO.
Methods: We conducted a prospective study of severe CDH patients undergoing FETO at an experienced North American center from 2015-2021 (NCT02710968). This group was compared to a cohort of non-FETO CDH patients with severe disease as defined by liver herniation, large defect size, and/or ECMO use. Clinical data were collected through a multidisciplinary CDH clinic. Statistics were performed with t-tests and Chi-squared analyses (p≤0.05).
Results: There were 18 FETO and 17 non-FETO patients. ECMO utilization was 56% in the FETO cohort. Despite significantly lower median observed/expected lung-to-head ratio (O/E LHR) in the FETO group, [FETO: 23% (IQR:18-25) vs. non-FETO: 36% (IQR: 28-41), p<0.001], there were comparable survival rates at discharge (FETO: 78% vs. non-FETO: 59%, p = 0.23) and at 5-years (FETO: 67% vs. non-FETO: 59%, p = 0.53) between the two cohorts. At a median follow up of 5.8 years, metrics of pulmonary hypertension, pulmonary morbidity, and gastroesophageal reflux disease improved among patients after FETO. However, most FETO patients remained on bronchodilators/inhaled corticosteroids (58%) and were feeding tube dependent (67%).
Conclusions: These North American data show that prenatal tracheal occlusion, in conjunction with a long-term multidisciplinary CDH clinic, is associated with acceptable long-term survival and morbidity in children after FETO.
Level of evidence: Level III.
Keywords: Congenital diaphragmatic hernia; Fetal therapy; Fetoscopic endoluminal tracheal occlusion.
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