Congenital diaphragmatic hernia treated via fetal endoscopic tracheal occlusion improves outcome in a middle-income country

Amanda Manfroi; Lisandra S. Bernardes; Luiza M.C. de Oliveira; Stela V. Peres; Werther B. de Carvalho; Ana C.A. Tannuri; Marcos M. da Silva; Juliana Z. del Bigio; Antonio G. de Amorim Filho; Mário Henrique Burlacchini de Carvalho; Rossana Pulcineli Vieira de Francisco; Mariana A. Carvalho

doi:10.1515/jpm-2024-0070

Article

Congenital diaphragmatic hernia treated via fetal endoscopic tracheal occlusion improves outcome in a middle-income country

Amanda Manfroi , Lisandra S. Bernardes , Luiza M.C. de Oliveira , Stela V. Peres , Werther B. de Carvalho , Ana C.A. Tannuri , Marcos M. da Silva , Juliana Z. del Bigio , Antonio G. de Amorim Filho , Mário Henrique Burlacchini de Carvalho , Rossana Pulcineli Vieira de Francisco and Mariana A. Carvalho

Published/Copyright: June 27, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 7

Abstract

Objectives

A recent European randomized trial – Tracheal Occlusion To Accelerate Lung Growth – demonstrated that fetoscopic endoluminal tracheal occlusion (FETO) is associated with increased postnatal survival among infants with severe congenital diaphragmatic hernia (CDH). However, this differs in middle-income countries such as Brazil, where abortion is illegal and neonatal intensive care is inadequate. This study evaluated the effects of FETO on improving the survival of infants with moderate-to-severe CDH in isolated and non-isolated cases.

Methods

This retrospective cohort study selected 49 fetuses with CDH, a normal karyotype, and a lung-to-head ratio (LHR) of <1 from a single national referral center for fetal surgery in São Paulo, Brazil, between January 2016 and November 2019. FETO was performed between 26 and 29 weeks of gestation. The primary outcomes were infant survival until discharge from the neonatal intensive care unit and survival until six months of age.

Results

Forty-six women with singleton fetuses having severe CDH underwent prenatal intervention with FETO. Infant survival rates until discharge and at six months of age were both 38 %. The observed-to-expected LHR increased by 25 % after FETO in neonates who survived until discharge. Spontaneous intrauterine death occurred in four growth-restricted fetuses after FETO. Preterm birth in <37 weeks and preterm rupture of membranes in <34 weeks occurred in 56.5 % (26) and 26 % (12) cases, respectively.

Conclusions

FETO may increase neonatal survival in fetuses with severe CDH, particularly in countries with limited neonatal intensive care.

Keywords: congenital diaphragmatic hernia; fetal endoscopic tracheal occlusion; lung-to-head ratio; neonatal intensive care unit; neonatal survival

Corresponding author: Mariana A. Carvalho, Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil, E-mail: mariana.azevedo@hc.fm.usp.br

Research ethics: The research related to human use has complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ Institutional Review Board (CAPPesp, CAEE:26529419.0.0000.0068).
Informed consent: Not applicable.
Author contributions: All authors adhere to the guidelines for authorship that are applicable in their specific research field. Each author listed meet all four criteria of authorship. 1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND; 2. Drafting the work or revising it critically for important intellectual content; AND; 3. Final approval of the version to be published; AND 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available duo to privacy and ethical restrictions.

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Received: 2024-02-23

Accepted: 2024-06-03

Published Online: 2024-06-27

Published in Print: 2024-09-25

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Articles in the same Issue

https://doi.org/10.1515/jpm-2024-0070

Keywords for this article

congenital diaphragmatic hernia; fetal endoscopic tracheal occlusion; lung-to-head ratio; neonatal intensive care unit; neonatal survival