Download PDF
Eur J Pediatr Surg 2017; 27(04): 297-305
DOI: 10.1055/s-0036-1587331
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Procedure-Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta-Analysis in the FETO Era

Edward Araujo Júnior
1   Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
,
Gabriele Tonni
2   Department of Obstetrics and Gynaecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
,
Wellington P. Martins
3   Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, São Paulo University (FMRP-USP), Ribeirão Preto-SP, Brazil
,
Rodrigo Ruano
4   Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States
› Author Affiliations
Further Information

Publication History

21 June 2016

25 June 2016

Publication Date:
14 August 2016 (online)

Also available at
    Permissions and Reprints

Corrected by:

Erratum: Procedure-Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta-Analysis in the FETO EraEur J Pediatr Surg 2017; 27(04): e1-e1
DOI: 10.1055/s-0036-1592407

Abstract

Introduction This study aims to assess the procedure-related complications and survival following fetoscopic endotracheal occlusion (FETO) for severe congenital diaphragmatic hernia.

Materials and Methods A systematic review and meta-analysis of PubMed and Scopus database searching for FETO procedure in severe CDH (lung-to-head ratio [LHR] < 1.0 and/or observed/expected LHR < 0.26 and > 1/3 liver herniation) were performed. The relative risk was assessed and 95% confidence interval (CI) calculated. Procedure complications and survival were compared between FETO and randomized controlled trial (RCT) as well as observational case–control studies.

Results A total of 4,807 records were retrieved based on the title and abstracts, and 18 studies were eligible for statistical analysis (1 RCT and 17 observational case–control studies). Relative risk (95% CI) comparing FETO and controls for premature rupture of membrane, preterm birth < 32 weeks, preterm birth < 37 weeks, survival at 30 days, and survival at 6 months were 1.7 (0.8–2.4), 7.3 (0.4–134), 1.8 (0.8–3.9), 5.8 (1.5–22.9), and 10.5 (1.5–74.7), respectively. Mean difference (95% CI) for gestational age at delivery comparing FETO and controls was 1.8 (−3.1 to −0.5). All these outcomes showed a low level of evidence.

Conclusion FETO procedure increased the neonatal survival at 30 days and 6 months; however, it presented a higher rate of premature rupture of membrane, preterm birth < 37 weeks, and decreased the gestational age at delivery by 2 weeks. Nonetheless, the level of evidence is low for all these outcomes. We suggested a large international multicenter RCT to prove the real benefits of FETO.

Keywords

procedure-related complications - survival - severe congenital diaphragmatic hernia - FETO - systematic review
 

  • References

  • 1 Langham Jr MR, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol 1996; 23 (04) 671-688
    CrossrefPubMedSearch in Google Scholar
  • 2 Witters I, Legius E, Moerman P. , et al. Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet 2001; 103 (04) 278-282
    CrossrefPubMedSearch in Google Scholar
  • 3 Bagolan P, Morini F. Long-term follow up of infants with congenital diaphragmatic hernia. Semin Pediatr Surg 2007; 16 (02) 134-144
    CrossrefPubMedSearch in Google Scholar
  • 4 Harrison MR, Adzick NS, Estes JM, Howell LJ. A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA 1994; 271 (05) 382-384
    CrossrefPubMedSearch in Google Scholar
  • 5 Ruano R, Bunduki V, Silva MM. , et al. Prenatal diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics (Sao Paulo) 2006; 61 (03) 197-202
    PubMedSearch in Google Scholar
  • 6 Deprest J, Gratacos E, Nicolaides KH. ; FETO Task Group. Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol 2004; 24 (02) 121-126
    CrossrefPubMedSearch in Google Scholar
  • 7 Bratu I, Flageole H, Laberge JM, Chen MF, Piedboeuf B. Pulmonary structural maturation and pulmonary artery remodeling after reversible fetal ovine tracheal occlusion in diaphragmatic hernia. J Pediatr Surg 2001; 36 (05) 739-744
    CrossrefPubMedSearch in Google Scholar
  • 8 Jani JC, Nicolaides KH, Gratacós E. , et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2009; 34 (03) 304-310
    CrossrefPubMedSearch in Google Scholar
  • 9 Harrison MR, Sydorak RM, Farrell JA, Kitterman JA, Filly RA, Albanese CT. Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial. J Pediatr Surg 2003; 38 (07) 1012-1020
    CrossrefPubMedSearch in Google Scholar
  • 10 Ruano R, Yoshisaki CT, da Silva MM. , 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Wells GA, Shea B, O'Connell D. , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed February 23, 2014
    PubMed
  • 12 Guyatt G, Oxman AD, Akl EA. , et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64 (04) 383-394
    CrossrefPubMedSearch in Google Scholar
  • 13 Peralta CF, Sbragia L, Bennini JR, Cavalli RC, Rousselet MS, Barini R. Tracheal occlusion for fetuses with severe isolated left-sided diaphragmatic hernia: a nonrandomized controlled experimental study [in Portuguese]. Rev Bras Ginecol Obstet 2011; 33 (12) 381-387
    PubMedSearch in Google Scholar
  • 14 Ruano R, Duarte SA, Pimenta EJ. , 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
    CrossrefPubMedSearch in Google Scholar
  • 15 Doné E, Gratacos E, Nicolaides KH. , et al. Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2013; 42 (01) 77-83
    PubMedSearch in Google Scholar
  • 16 Ruano R, Peiro JL, da Silva MM. , et al. Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results. Ultrasound Obstet Gynecol 2013; 42 (01) 70-76
    PubMedSearch in Google Scholar
  • 17 Cannie MM, Cordier AG, De Laveaucoupet J. , et al. Liver-to-thoracic volume ratio: use at MR imaging to predict postnatal survival in fetuses with isolated congenital diaphragmatic hernia with or without prenatal tracheal occlusion. Eur Radiol 2013; 23 (05) 1299-1305
    CrossrefPubMedSearch in Google Scholar
  • 18 Rocha LA, Byrne FA, Keller RL. , et al. Left heart structures in human neonates with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion. Fetal Diagn Ther 2014; 35 (01) 36-43
    CrossrefPubMedSearch in Google Scholar
  • 19 DeKoninck P, Gomez O, Sandaite I. , et al. Right-sided congenital diaphragmatic hernia in a decade of fetal surgery. BJOG 2015; 122 (07) 940-946
    CrossrefPubMedSearch in Google Scholar
  • 20 Jani JC, Nicolaides KH, Gratacós E, Vandecruys H, Deprest JA. ; FETO Task Group. Fetal lung-to-head ratio in the prediction of survival in severe left-sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO). Am J Obstet Gynecol 2006; 195 (06) 1646-1650
    CrossrefPubMedSearch in Google Scholar
  • 21 Fayoux P, Hosana G, Devisme L. , et al. Neonatal tracheal changes following in utero fetoscopic balloon tracheal occlusion in severe congenital diaphragmatic hernia. J Pediatr Surg 2010; 45 (04) 687-692
    CrossrefPubMedSearch in Google Scholar
  • 22 Cruz-Martínez R, Moreno-Alvarez O, Hernández-Andrade 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
    CrossrefPubMedSearch in Google Scholar
  • 23 Peralta CF, Sbragia L, Bennini JR. , et al. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther 2011; 29 (01) 71-77
    CrossrefPubMedSearch in Google Scholar
  • 24 Jani J, Valencia C, Cannie M, Vuckovic A, Sellars M, Nicolaides KH. Tracheal diameter at birth in severe congenital diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Prenat Diagn 2011; 31 (07) 699-704
    CrossrefPubMedSearch in Google Scholar
  • 25 Done E, Allegaert K, Lewi P. , et al. Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2011; 37 (03) 264-271
    CrossrefPubMedSearch in Google Scholar
  • 26 Cruz-Martinez R, Castañon M, Moreno-Alvarez O, Acosta-Rojas R, Martinez JM, Gratacos E. Usefulness of lung-to-head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2013; 41 (01) 59-65
    CrossrefPubMedSearch in Google Scholar
  • 27 Ali K, Grigoratos D, Cornelius V, Davenport M, Nicolaides K, Greenough A. Outcome of CDH infants following fetoscopic tracheal occlusion - influence of premature delivery. J Pediatr Surg 2013; 48 (09) 1831-1836
    CrossrefPubMedSearch in Google Scholar
  • 28 Roos C, Schuit E, Scheepers HC. , et al; for APOSTEL-II Study Group. Predictive factors for delivery within 7 days after successful 48-hour treatment of threatened preterm labor. AJP Rep 2015; 5 (02) e141-e149
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Sun J, Qu S, Zhang C, Xiang Z, Fu Z, Yao L. Neonatal mortality rate and risk factors in northeast China: analysis of 5,277 neonates in 2005. Clin Exp Obstet Gynecol 2014; 41 (05) 512-516
    PubMedSearch in Google Scholar
  • 30 Peeters SH, Van Zwet EW, Oepkes D, Lopriore E, Klumper FJ, Middeldorp JM. Learning curve for fetoscopic laser surgery using cumulative sum analysis. Acta Obstet Gynecol Scand 2014; 93 (07) 705-711
    CrossrefPubMedSearch in Google Scholar
  • 31 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 (e-pub ahead of print). doi: 10.1097/SLA.0000000000001675
    PubMed