Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia

Cruz‐Martínez, R.; Shazly, Sherif; Martínez‐Rodríguez, Miguel; Gámez-Varela, Alma; Luna‐García, Jonahtan; Juárez‐Martínez, I.; López‐Briones, Hugo; Coronel-Cruz, Fausto; Villalobos‐Gómez, R.; Ibarra-Ríos, Daniel; Ordorica-Flores, Ricardo; Nieto-Zermeño, Jaime

doi:10.1002/pd.5988

Cited by 4 publications

(10 citation statements)

References 26 publications

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“…By including the largest sample size of CDH patients treated with FETO and a control group, our analysis provides more reliable evidence regarding the effects of 36 Severe Belfort (2017) 28 Deprest (2021) 12 Ruano (2012) 21 Style (2019) 32 Subtotal (95% CI) Total events…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…Total (95% CI) Deprest (2021) 13 Test for subgroup differences: chi 2 = 1.68, df = 1 (P = 0. 36 Deprest (2021) 13 Deprest (2021) 12 Ruano (2012) 21 Doné (2013) 22 Early FETO Deprest (2021) 12 Doné (2013) 22 Moderate Severe Deprest (2021) 13 Dhillon (2018) 29 Deprest (2021) 12 Style (2019) 32 Belfort (2017) 28 Late FETO Deprest (2021) 13 Cruz-Martínez (2022) 36 Deprest (2021) 13 Cruz-Martínez (2020) 34 Cruz-Martínez (2020) 34 Cruz-Martínez (2022) 36 Deprest (2021) 13 Deprest (2021) 12 Ruano (2012) 21 Deprest (2021) 12 Deprest (2021) 13 Severe Deprest (2021) 12 Ruano (2013) 23 Ruano (2011) 19 Ruano (2012) 21 Subtotal (95% CI) FETO on the prognosis of CDH compared with previous studies [7][8][9][10][11] . Our study has several novel findings.…”

Section: Total Eventsmentioning

confidence: 99%

“…The mortality of CDH patients at 6 months 12,13,21,28,29,32,36 , 1 month 12,13 and 12 months 28,32 was evaluated. FETO significantly reduced the 6-month mortality of CDH (OR, 0.34 (95% CI, 0.18-0.65); P = 0.0009, I 2 = 41%, NNT = 5.26) (Figure 3a).…”

Section: Mortalitymentioning

confidence: 99%

“…Data on pulmonary hypertension were extracted from five studies 12,13,21,22,36 . FETO had no effect on the overall rate of pulmonary hypertension (OR, 0.60 (95% CI, 0.27-1.36); P = 0.22, I 2 = 37%) (low quality of evidence) (Figure 4a).…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

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

Chen

Xie

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?There is an ongoing debate regarding whether the impact of fetal endoscopic tracheal occlusion (FETO) varies in severe and moderate congenital diaphragmatic hernia (CDH). We demonstrate that FETO is associated with a reduction in mortality, rate of pulmonary hypertension and use of extracorporeal membrane oxygenation (ECMO) in severe CDH, but reduces only mortality in moderate CDH. In addition, FETO is associated with late preterm birth (but not extreme prematurity) regardless of CDH severity or timing of FETO. What are the clinical implications of this work?FETO should be recommended primarily for severe CDH to reduce mortality, risk of pulmonary hypertension and ECMO usage. Patients should be informed regarding the increased risk of late prematurity but not of extreme prematurity. Further evaluation is warranted to clarify the risk/benefit ratio of FETO in moderate CDH.

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Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Total Eventsmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Pulmonary Hypertensionmentioning

confidence: 99%

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

Chen

Xie

et al. 2023

Ultrasound in Obstet & Gyne

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“…prenatal diagnosis, standardized severity assessment in the second or early third trimester, live born after 30 weeks and all managed with a standardized postnatal protocol) and reporting all core outcomes 19 . For example, fetal surgeons from Queretaro, 20,21 Mexico concluded that in their setting with suboptimal neonatal management, the postnatal outcome of CDH is less favourable than that observed elsewhere. The same was earlier reported in a study from Brazil 22 .…”

Section: The Natural History Of Congenital Diaphragmatic Hernia Is Qu...mentioning

confidence: 99%

Antenatal management of congenital diaphragmatic hernia: What's next ?

et al. 2022

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Congenital diaphragmatic hernia can be diagnosed in the prenatal period and its severity can be measured by fetal imaging. There is now level I evidence that, in selected cases, Fetoscopic Endoluminal Tracheal Occlusion with a balloon increases survival to discharge from the neonatal unit as well as the risk for prematurity. Both effects are dependent on the time point of tracheal occlusion. Fetoscopic Endoluminal Tracheal Occlusion may also lead to iatrogenic death when the balloon cannot be timely retrieved. The implementation of the findings from our clinical studies, may also vary based on local conditions. These may be different in terms of available skill set, access to fetal therapy, as well as outcome based on local neonatal management. We encourage prior benchmarking of local outcomes with optimal postnatal management, based on large enough numbers and using identical criteria as in the recent trials. We propose to work further on prenatal prediction methods, and the improvement of fetal intervention. In this manuscript, we describe a research agenda from a fetal medicine perspective. This research should be in parallel with innovation in neonatal and pediatric (surgical) management of this condition. Kypros H. Nicolaides and Jan Deprest have contributed equally to this manuscript.

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Does Prediction of Neonatal Mortality by the Observed/Expected Lung-To-Head Ratio Change during Pregnancy in Fetuses with Left Congenital Diaphragmatic Hernia?

Huntley¹,

Hernández‐Andrade²,

Bartal³

et al. 2023

Fetal Diagn Ther

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Introduction: The aim of this study was to evaluate prediction of neonatal mortality in fetuses with isolated left congenital diaphragmatic hernia (CDH) when the observed/expected lung-to-head ratio (O/E LHR) was estimated at two different gestational time points during pregnancy. Methods: Forty-four (44) fetuses with isolated left CDH were included. O/E LHR was estimated at the time of referral (first scan) and before delivery (last scan). The main outcome was neonatal death due to respiratory complications. Results: There were 10/44 (22.7%) perinatal deaths. The areas under (AU) the ROC curves were: first scan, 0.76, best O/E LHR cut-off 35.5% with 76% sensitivity and 70% specificity; last scan, AU-ROC 0.79, best O/E LHR cut-off 35.2%, with 79.0% sensitivity and 80% specificity. Considering an O/E LHR cut-off ≤35% to define high-risk fetuses at any examination, prediction for perinatal mortality showed: 80% sensitivity, 73.5% specificity, 47.1% positive and 92.6% negative predictive values, and 3.02 (95% CI 1.59–5.73) positive and 0.27 (95% CI 0.08–0.96) negative likelihood ratios. Prediction was similar in the two evaluations as 16/21 (76.2%) of fetuses considered at risk had an O/E LHR ≤35% in the two examinations; in the remaining 5 cases, two were identified only in the first and three only in the last scan. Conclusion: The O/E LHR is a good predictor of perinatal death in fetuses with left isolated CDH. Approximately 80% of fetuses at risk of perinatal death can be identified with an O/E LHR ≤35%, and 90% of them will have similar O/E LHR values at the first and at the last ultrasound examinations prior to delivery. In general, 88.6% of all CDH fetuses have a similar severity classification based on the O/E LHR at the first diagnostic ultrasound or at the ultrasound examination prior to delivery.

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Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia

Cited by 4 publications

References 26 publications

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

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

Antenatal management of congenital diaphragmatic hernia: What's next ?

Does Prediction of Neonatal Mortality by the Observed/Expected Lung-To-Head Ratio Change during Pregnancy in Fetuses with Left Congenital Diaphragmatic Hernia?

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