Outcome of CDH infants following fetoscopic tracheal occlusion - influence of premature delivery.
OBJECTIVE
To evaluate the mortality and morbidity of infants with congenital diaphragmatic hernia who had undergone fetal endoscopic tracheal occlusion (FETO) and whether this was influenced by premature birth.


METHODS
The gestational age at delivery, lung-head ratio (LHR) pre and post FETO, neonatal outcomes, and respiratory, gastro-intestinal, neurological, surgical, and musculoskeletal problems at follow up of consecutive infants who had undergone FETO were determined. Elective reversal of FETO was planned at 34 weeks of gestation.


RESULTS
The survival rate of the 61 FETO infants was 48%, with 84% delivered prematurely. Thirty-one delivered <35 weeks of gestation. Their survival rate was 18%. Twenty-three of 24 infants who had emergency balloon removal were born <35 weeks of gestation. Survival was related to gestational age at delivery (OR 0.55, 95% CI 0.420, 0.77, p<0.001) and the duration of FETO (OR 0.73, 95% CI 0.59, 0.91, p<0.005). Infants born prior to 35 weeks of gestation compared to those born at ≥ 35 weeks required a longer duration of ventilation (median 45 days versus 12 days, p<0.001), and a greater proportion had surgery for gastro-oesophageal reflux (50% versus 9%, p=0.011).


CONCLUSIONS
These results emphasize the need to reduce premature delivery following FETO.
Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, United Kingdom.
Kamal
K
Ali
Dionysios
D
Grigoratos
Victoria
V
Cornelius
Mark
M
Davenport
Kypros
K
Nicolaides
Anne
A
Greenough
D002508:Cephalometry; D036861:Delivery, Obstetric; D017558:Elective Surgical Procedures; D005260:Female; D005325:Fetal Organ Maturity; D005332:Fetoscopy; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D005865:Gestational Age; D006257:Head / Q000033:anatomy & histology / Q000196:embryology; D006548:Hernia, Diaphragmatic / Q000196:embryology / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000033:anatomy & histology / Q000196:embryology; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D060205:Therapeutic Occlusion / Q000379:methods*; D014132:Trachea / Q000196:embryology; D016896:Treatment Outcome
Congenital diaphragmatic hernia; Fetal endoscopic occlusion of trachea; Prematurity