Survival outcomes in severe left diaphragmatic hernia with and without fetoscopic tracheal occlusion in a country with suboptimal neonatal management.
Cruz-Martínez R1,2, Martínez-Rodríguez M1,2, Gámez-Varela A1, Nieto-Castro B1, Luna-García J1, Juárez-Martínez I1, López-Briones H1, Guadarrama-Mora R1,2, Torres-Torres J3, Coronel-Cruz F3, Ibarra-Rios D4, Ordorica-Flores R4, Nieto-Zermeño J4.
To evaluate the impact of Fetal Endoscopic Tracheal Occlusion (FETO) in improving survival for fetuses with severe left congenital diaphragmatic hernia (CDH) and temporary cases managed expectantly during pregnancy in a country with suboptimal neonatal management.
A cohort of consecutive, isolated left-sided CDH fetuses with normal karyotype and severe pulmonary hypoplasia (liver herniation and observed/expected lung area to head ratio below 26%) were selected for FETO at less than 32 weeks of gestation in a single tertiary referenced center in Queretaro, Mexico. Postnatal outcome (survival up to 28 days after birth) between fetuses treated with FETO and temporary cases with similar lung size but managed expectantly during pregnancy was compared.
25 CDH fetuses treated with FETO were individually matched with 25 counterparts managed expectantly during pregnancy. Endotracheal placement of the balloon was successfully performed at the first attempt in all cases. The median gestational age at balloon placement was 29.3 weeks (range, 25.6-31.8 weeks), and 34.1 weeks (range, 30.0-36.1 weeks) at balloon removal. There were no technical problems in the introduction or removal of the balloon in all cases. The median gestational age at delivery was significantly lower in the group with FETO than in those managed expectantly (35.6 weeks vs. 37.0 weeks, p=0.04, respectively). Survival rate was significantly higher in the group with FETO than in those without fetal intervention (32% vs. 0%, p<0.01 respectively).
In settings with suboptimal neonatal management, FETO was associated with improved neonatal survival in CDH fetuses with severe lung hypoplasia. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Congenital diaphragmatic hernia; fetal surgery; tracheal occlusionPMID: 32068928 DOI: 10.1002/uog.21993