title: Fetal Tracheal Occlusion for Severe Pulmonary Hypoplasia in Isolated Congenital Diaphragmatic Hernia: A Systematic Review and Meta-analysis of Survival.
abstract: OBJECTIVE
  To evaluate fetal survival after tracheal occlusion in fetuses with severe pulmonary hypoplasia and isolated congenital diaphragmatic hernia (CDH).
  
  
  BACKGROUND
  Despite recent advances in neonatal intensive care, CDH still has a high mortality and morbidity. Fetoscopic endoluminal tracheal occlusion (FETO) stimulates lung growth and improves gas exchange in animal models of CDH, but the effects in humans are still under investigation.
  
  
  METHODS
  We searched Pubmed, Cochrane, EMBASE, and Scopus databases for clinical studies on tracheal occlusion and CDH. All studies comparing FETO and a contemporary control group were included. The primary outcome was survival, with the need for oxygen on discharge the secondary outcome. Meta-analysis of outcome measures was performed and odds ratios, relative risk ratios, and 95% confidence intervals were estimated with a fixed-effects model and were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.
  
  
  RESULTS
  Between 1997 and 2015, five eligible studies describing 211 patients were included (101 control and 110 FETO). All studies selected isolated severe CDH fetuses with a lung-to-head ratio 1.0 or less and liver herniation into the thoracic cavity. FETO favored survival outcome (odds ratio 13.32; 95% confidence interval, 5.40-32.87). Meta-analysis of the secondary outcome oxygen need at discharge could not be calculated, because it was not reported in all included studies.
  
  
  CONCLUSIONS
  FETO improves survival in isolated CDH with severe pulmonary hypoplasia compared with the standard perinatal management.
authors.affiliation: *Department of Surgery, Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada†Clinical department of Obstetrics and Gynaecology, UZ Leuven and Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium‡Departments of Pediatrics & Child Health and Physiology & Pathophysiology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Biology of Breathing Theme, Winnipeg, Manitoba, Canada§Department Obstetrics and Gynaecology, University College London, London, United Kingdom.
authors.forename: Jamila
authors.initials: J
authors.lastname: Al-Maary
authors.forename: Mary P
authors.initials: MP
authors.lastname: Eastwood
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Russo
authors.forename: Jan A
authors.initials: JA
authors.lastname: Deprest
authors.forename: Richard
authors.initials: R
authors.lastname: Keijzer
mesh_terms: D005260:Female; D005332:Fetoscopy / Q000379:methods*; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000002:abnormalities*; D011247:Pregnancy; D016019:Survival Analysis; D014132:Trachea / Q000601:surgery*