fbpx
You Are Reading

Research: Morbidity in children after fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: Results from a multidisciplinary clinic

0
Uncategorized

Research: Morbidity in children after fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: Results from a multidisciplinary clinic

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 1Melanie K Nies 2Jena L Miller 3Alejandro V Garcia 1Erica I Hodgman 1Annalise B Penikis 1Abigail J Engwall-Gill 1Vera Joanna Burton 4Jessica L Rice 5Peter J Mogayzel 5Ahmet A Baschat 3Shaun M Kunisaki 6

Affiliations expand

Abstract

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.

cuevana 3

Follow @ Instagram

Translate »

TasteKid.com provides Menu of different Restaurant. Now get all Restaurant Menu, Prices, Catering, Near Me locations, Open Hours. You can quickly find Near me Restaurants around your place.

123 movies soap2day