title: Procedure-Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta-Analysis in the FETO Era.
abstract: IntroductionThis study aims to assess the procedure-related complications and survival following fetoscopic endotracheal occlusion (FETO) for severe congenital diaphragmatic hernia.Materials and MethodsA 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.ResultsA 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.ConclusionFETO 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.
authors: Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
authors: Edward
authors: E
authors: Araujo Júnior
authors: Department of Obstetrics and Gynaecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.
authors: Gabriele
authors: G
authors: Tonni
authors: Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, São Paulo University (FMRP-USP), Ribeirão Preto-SP, Brazil.
authors: Wellington P
authors: WP
authors: Martins
authors: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, United States.
authors: Rodrigo
authors: R
authors: Ruano
mesh_terms: D005260:Female; D005332:Fetoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D012720:Severity of Illness Index; D015996:Survival Rate; D060205:Therapeutic Occlusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome