title: Prenatal intervention for isolated congenital diaphragmatic hernia.
abstract: OBJECTIVE
  We aim to review the recent literature regarding early prenatal prediction of outcome in babies diagnosed with isolated congenital diaphragmatic hernia, as well as results of fetal therapy for this condition.
  
  
  RESULTS
  Current survival rates in population-based studies are around 55-70%. Highly specialized centers report 80% and more, but discount the hidden mortality, mainly in the antenatal period. Fetuses presenting with liver herniation and a lung-to-head ratio of less than 1.0 measured in midgestation have a poor prognosis. Other volumetric techniques are being evaluated for use in midtrimester. Recently, a randomized trial failed to show benefit from prenatal therapy, but lacked power to document the potential advantage of prenatal therapy in severe cases. We proposed percutaneous fetal endoluminal tracheal occlusion with a balloon at 26-28 weeks through a 3.3 mm incision. In severe cases, fetal endoluminal tracheal occlusion increased lung size as well as survival, with an early (7 day) survival, late neonatal (28 day) survival and survival at discharge of 75, 58 and 50%, respectively, comparing favorably with 9% in contemporary controls. Airways can be restored prior to birth improving neonatal survival (83.3% compared with 33.3%). The procedure carries a risk for preterm prelabour rupture of the fetal membranes, although that may decrease with experience.
  
  
  CONCLUSIONS
  Fetuses with severe congenital diaphragmatic hernia can be identified in the second trimester. Fetal endoluminal tracheal occlusion can be considered as a minimally invasive fetal therapy, improving outcome in such highly selected cases.
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium. Jan.Deprest@uz.kuleuven.ac.be
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Jacques
authors.initials: J
authors.lastname: Jani
authors.forename: Mieke
authors.initials: M
authors.lastname: Cannie
authors.forename: Anne
authors.initials: A
authors.lastname: Debeer
authors.forename: Marc
authors.initials: M
authors.lastname: Vandevelde
authors.forename: Elisa
authors.initials: E
authors.lastname: Done
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gratacos
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaïdes
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000628:therapy*; D005332:Fetoscopy; D006548:Hernia, Diaphragmatic / Q000175:diagnosis; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D016216:Ultrasonography, Prenatal