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DOI: 10.1055/s-0041-1740596
Perinatal Outcomes after Fetal Endoscopic Tracheal Occlusion for Isolated Congenital Diaphragmatic Hernia: Rapid Review
Resultados perinatais após oclusão traqueal endoscópica fetal por hérnia diafragmática congênita isolada: Revisão rápidaAbstract
Objective To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management.
Data sources In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included.
Study selection We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCT met the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group).
Data collection Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading).
Data synthesis There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6 ± 2.4 weeks in the intervention group, and of 37.4 ± 1.9 weeks among the controls (p < 0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls (p < 0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5–74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls (p = 0.02; relative risk: 0.6; 95%CI: 0.4–0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low.
Conclusion Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.
Resumo
Objetivo Comparar os resultados perinatais de fetos com hérnia diafragmática congênita após oclusão traqueal endoscópica fetal (OTEF) e conduta expectante pré-natal.
Fontes dos dados Nesta revisão rápida, pesquisas foram conduzidas nas bases de dados MEDLINE, PMC, EMBASE e CENTRAL entre 10 de agosto de 2020 e 4 de setembro de 2020. Ensaios clínicos randomizados (ECRs), quase-ECRs e ECRs em cluster publicados em inglês nos últimos dez anos foram incluídos.
Seleção dos estudos Foram recuperadas 203 publicações; 180 destas foram triadas pelo resumo. Fez-se a leitura do texto completo de 8 estudos, e 1 ECR cumpriu os critérios de inclusão (41 mulheres aleatorizadas; 20 no grupo OTEF e 21 no grupo de controle).
Coleta de dados A coleta de dados realizada independentemente pelos dois autores, em duas etapas (título e resumo, e leitura do texto completo).
Síntese dos dados Não houve casos de morte materna. A idade gestacional média no parto foi de 35,6 ± 2,4 semanas no grupo de intervenção, e de 37,4 ± 1,9 semanas entre os controles (p < 0,01). A sobrevida até 6 meses de idade foi relatada em 50% do grupo de intervenção, e em 5,8% dos controles (p < 0,01; risco relativo: 10,5; intervalo de confiança de 95% [IC95%]: 1,5–74,7). Hipertensão pulmonar grave ocorreu em 50% dos lactentes do grupo de intervenção, e em 85,7% dos controles (p = 0.02; risco relativo: 0,6; IC95%: 0,4–0,9). Uma análise do estudo indicou algumas preocupações quanto ao risco de viés. A qualidade da evidência foi considerada de moderada a baixa.
Conclusão As evidências atuais são limitadas, mas sugerem que a OTEF pode ser uma intervenção eficaz para melhorar resultados perinatais.
Keywords
congenital diaphragmatic hernias - ultrasound diagnosis - prenatal ultrasonography - prognosis - systematic reviewPalavras-chave
hérnias diafragmáticas congênitas - ultrassonografia - ultrassonografia pré-natal - prognóstico - revisão sistemáticaPublication History
Received: 12 April 2021
Accepted: 15 September 2021
Article published online:
29 January 2022
© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Hedrick HL, Adzick NS. Congenital diaphragmatic hernia: prenatal issues [Internet]. 2020 [cited 2020 Oct 15]. Available from: https://www.uptodate.com/contents/congenital-diaphragmatic-hernia-prenatal-issues
- 2 Russo FM, Cordier AG, De Catte L, Saada J, Benachi A, Deprest J. Workstream Prenatal Management, ERNICA European reference network. Proposal for standardized prenatal ultrasound assessment of the fetus with congenital diaphragmatic hernia by the European reference network on rare inherited and congenital anomalies (ERNICA). Prenat Diagn 2018; 38 (09) 629-637 DOI: 10.1002/pd.5297.
- 3 Puligandla PS, Skarsgard ED, Offringa M, Adatia I, Baird R. et al; Canadian Congenital Diaphragmatic Hernia Collaborative. Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline. CMAJ 2018; 190 (04) E103-E112 DOI: 10.1503/cmaj.170206.
- 4 Grivell RM, Andersen C, Dodd JM. Prenatal interventions for congenital diaphragmatic hernia for improving outcomes. Cochrane Database Syst Rev 2015; 2015 (11) CD008925 DOI: 10.1002/14651858.CD008925.pub2.
- 5 Al-Maary J, Eastwood MP, Russo FM, Deprest JA, Keijzer R. Fetal tracheal occlusion for severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis of survival. Ann Surg 2016; 264 (06) 929-933 DOI: 10.1097/SLA.0000000000001675.
- 6 Ali K, Bendapudi P, Polubothu S, Andradi G, Ofuya M, Peacock J. et al. Congenital diaphragmatic hernia-influence of fetoscopic tracheal occlusion on outcomes and predictors of survival. Eur J Pediatr 2016; 175 (08) 1071-1076 DOI: 10.1007/s00431-016-2742-6.
- 7 Ali K, Dassios T, Khaliq SA, Williams EE, Tamura K, Davenport M. et al. Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era. Pediatr Surg Int 2019; 35 (07) 743-747 DOI: 10.1007/s00383-019-04484-3.
- 8 Garritty C, Gartlehner G, Kamel C, King VJ, Nussbaumer-Streit B, Stevens A. et al. Cochrane rapid reviews: interim guidance from the Cochrane Rapid Reviews Methods Group [Internet]. Mar 2020 [cited 2021 Jan 10]. Available from: https://methods.cochrane.org/rapidreviews/sites/methods.cochrane.org.rapidreviews/files/public/uploads/cochrane_rr_-_guidance-23mar2020-v1.pdf
- 9 Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898 DOI: 10.1136/bmj.l4898.
- 10 Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A. et al; GRADE Working Group. Going from evidence to recommendations. BMJ 2008; 336 (7652): 1049-1051 DOI: 10.1136/bmj.39493.646875.AE.
- 11 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P. et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336 (7650): 924-926 DOI: 10.1136/bmj.39489.470347.AD.
- 12 Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A. et al; GRADE Working Group. Incorporating considerations of resources use into grading recommendations. BMJ 2008; 336 (7654): 1170-1173 DOI: 10.1136/bmj.39504.506319.80.
- 13 Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ. GRADE Working Group. What is “quality of evidence” and why is it important to clinicians?. BMJ 2008; 336 (7651): 995-998 DOI: 10.1136/bmj.39490.551019.BE.
- 14 Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE. et al; GRADE Working Group. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008; 336 (7653): 1106-1110 DOI: 10.1136/bmj.39500.677199.AE.
- 15 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097 DOI: 10.1371/journal.pmed.1000097.
- 16 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5 (01) 210 DOI: 10.1186/s13643-016-0384-4.
- 17 McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021; 12 (01) 55-61 DOI: 10.1002/jrsm.1411.
- 18 Ruano R, Yoshisaki CT, da Silva MM, Ceccon ME, Grasi MS, Tannuri U. et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2012; 39 (01) 20-27 DOI: 10.1002/uog.10142.
- 19 Ruano R. Fetal tracheal occlusion in severe diaphragmatic hernia: a randomized trial [Internet]. São Paulo: University of São Paulo; 2011. [cited 2021 Jan 12]. NCT01302977. Available from: https://clinicaltrials.gov/ct2/show/NCT01302977
- 20 Aydin E, Joshi R, Oria M, Varisco BM, Lim FY, Peiro JL. Fetal tracheal occlusion in mice: a novel transuterine method. J Surg Res 2018; 229: 311-315 DOI: 10.1016/j.jss.2018.04.028.
- 21 Baba JS, McKnight TE, Ericson MN, Johnson A, Moise Jr KJ, Evans III BM. Characterization of a reversible thermally-actuated polymer-valve: A potential dynamic treatment for congenital diaphragmatic hernia. PLoS One 2018; 13 (12) e0209855 DOI: 10.1371/journal.pone.0209855.
- 22 Cruz-Martínez R, Moreno-Alvarez O, Hernández-Andrade E, Castañón M, Martínez JM, Done E. et al. Changes in lung tissue perfusion in the prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion. Fetal Diagn Ther 2011; 29 (01) 101-107 DOI: 10.1159/000295262.
- 23 Degenhardt J, Enzensberger C, Tenzer A, Kawecki A, Kohl T, Widriani E. et al. Myocardial function pre- and post-Fetal Endoscopic Tracheal Occlusion (FETO) in fetuses with left-sided moderate to severe congenital diaphragmatic hernia. Ultraschall Med 2017; 38 (01) 65-70 DOI: 10.1055/s-0041-108501.
- 24 DeKoninck PLJ, Crossley KJ, Kashyap AJ, Skinner SM, Thio M, Rodgers KA. et al. Effects of tracheal occlusion on the neonatal cardiopulmonary transition in an ovine model of diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed 2019; 104 (06) F609-F616 DOI: 10.1136/archdischild-2018-316047.
- 25 Delabaere A, Blanchon L, Coste K, Clairefond G, Belville C, Blanc P. et al. Retinoic acid and tracheal occlusion for diaphragmatic hernia treatment in rabbit fetuses. Prenat Diagn 2018; 38 (07) 482-492 DOI: 10.1002/pd.5256.
- 26 Deprest J, Nicolaides K, Done' E, Lewi P, Barki G, Largen E. et al. Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. J Pediatr Surg 2011; 46 (01) 22-32 DOI: 10.1016/j.jpedsurg.2010.10.008.
- 27 Engels AC, Van Calster B, Richter J, DeKoninck P, Lewi L, De Catte L. et al. Collagen plug sealing of iatrogenic fetal membrane defects after fetoscopic surgery for congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2014; 43 (01) 54-59 DOI: 10.1002/uog.12547.
- 28 Engels AC, Brady PD, Kammoun M, Finalet FerreiroJ, DeKoninck P, Endo M. et al. Pulmonary transcriptome analysis in the surgically induced rabbit model of diaphragmatic hernia treated with fetal tracheal occlusion. Dis Model Mech 2016; 9 (02) 221-228 DOI: 10.1242/dmm.021626.
- 29 Mari G, Deprest J, Schenone M, Jackson S, Samson J, Brocato B. et al. A novel translational model of percutaneous fetoscopic endoluminal tracheal occlusion - baboons (Papio spp.). Fetal Diagn Ther 2014; 35 (02) 92-100 DOI: 10.1159/000357139.
- 30 Pereira-Terra P, Deprest JA, Kholdebarin R, Khoshgoo N, DeKoninck P, Munck AA. et al. Unique tracheal fluid microRNA signature predicts response to FETO in patients with congenital diaphragmatic hernia. Ann Surg 2015; 262 (06) 1130-1140 DOI: 10.1097/SLA.0000000000001054.
- 31 Ruano R, Duarte SA, Pimenta EJ, Takashi E, da Silva MM, Tannuri U. et al. Comparison between fetal endoscopic tracheal occlusion using a 1.0-mm fetoscope and prenatal expectant management in severe congenital diaphragmatic hernia. Fetal Diagn Ther 2011; 29 (01) 64-70 DOI: 10.1159/000311944.
- 32 Yao W, Elangovan H, Nicolaides K. Design of a flexible fetoscopy manipulation system for congenital diaphragmatic hernia. Med Eng Phys 2014; 36 (01) 32-38 DOI: 10.1016/j.medengphy.2013.08.014.
- 33 Barrett DW, David AL, Thrasivoulou C, Mata A, Becker DL, Engels AC. et al. Connexin 43 is overexpressed in human fetal membrane defects after fetoscopic surgery. Prenat Diagn 2016; 36 (10) 942-952 DOI: 10.1002/pd.4917.
- 34 Kirby E, Keijzer R. Congenital diaphragmatic hernia: current management strategies from antenatal diagnosis to long-term follow-up. Pediatr Surg Int 2020; 36 (04) 415-429 DOI: 10.1007/s00383-020-04625-z.
- 35 Jani JC, Nicolaides KH. Fetal surgery for severe congenital diaphragmatic hernia?. Ultrasound Obstet Gynecol 2012; 39 (01) 7-9 DOI: 10.1002/uog.11064.
- 36 Codsi E, Audibert F. Fetal surgery: past, present, and future perspectives. J Obstet Gynaecol Can 2019; 41 (Suppl. 02) S287-S289 DOI: 10.1016/j.jogc.2019.08.039.