Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico.
Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer 'Dr. Felipe Núñez-Lara', Queretaro, Mexico.
Ultrasound Obstet Gynecol. 2020 Oct;56(4):516-521. doi: 10.1002/uog.21993. Epub 2020 Aug 30.
To evaluate the impact of fetal endoscopic tracheal occlusion (FETO) on improving survival of fetuses with severe left-sided congenital diaphragmatic hernia (CDH), as compared with contemporaneous cases managed expectantly during pregnancy, in a country with suboptimal neonatal management.
In this prospective cohort study, consecutive fetuses with isolated left-sided CDH, normal karyotype and severe pulmonary hypoplasia (defined as liver herniation and observed/expected lung-to-head circumference ratio below 26%) were selected for FETO at less than 32 weeks of gestation in a single tertiary referral center in Queretaro, Mexico. Postnatal outcome (survival up to 28 days after birth) was compared between fetuses treated with FETO and contemporaneous cases with similar lung size managed expectantly during pregnancy.
Twenty-five fetuses with isolated severe left-sided CDH treated with FETO were matched individually with 25 cases managed expectantly during pregnancy. Endotracheal placement of the balloon was performed successfully on the first attempt in all cases. The median gestational age (GA) at balloon placement was 29.1 (range, 25.6-31.8) weeks and 34.1 (range, 30.0-36.1) weeks at balloon removal. There were no technical problems with the introduction or removal of the balloon in any cases. The median GA at delivery was significantly lower in the group treated with FETO than in those managed expectantly (35.3 vs 37.7 weeks; P = 0.04). The survival rate was significantly higher in the group treated with FETO than in those without fetal intervention (32% vs 0%; P < 0.001).
In settings with suboptimal neonatal management, FETO was associated with improved neonatal survival in fetuses with isolated left-sided CDH and severe pulmonary hypoplasia. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
评估胎儿内镜气管阻塞术（FETO）对改善严重左侧先天性膈疝（CDH）胎儿存活率的影响，与在新生儿管理欠佳的国家中妊娠期间接受期待治疗的同期病例相比。
在这项前瞻性队列研究中，连续选择了具有孤立性左侧 CDH、正常核型和严重肺发育不全（定义为肝疝出和观察/预计肺头比低于 26%）的胎儿，在墨西哥 Queretaro 的一家单一的三级转诊中心，在妊娠 32 周之前接受 FETO 治疗。FETO 治疗的胎儿与妊娠期间接受期待治疗的具有相似肺大小的同期病例的产后结局（出生后 28 天内的存活率）进行比较。
25 例患有孤立性严重左侧 CDH 的胎儿接受 FETO 治疗，与 25 例同期接受期待治疗的病例进行了个体匹配。所有病例的气管内球囊放置均首次成功完成。球囊放置的中位孕龄（GA）为 29.1（范围，25.6-31.8）周，球囊取出的中位 GA 为 34.1（范围，30.0-36.1）周。在任何情况下，引入或取出球囊均无技术问题。FETO 治疗组的分娩 GA 明显低于期待治疗组（35.3 与 37.7 周；P=0.04）。FETO 治疗组的存活率明显高于未行胎儿干预组（32%与 0%；P<0.001）。
在新生儿管理欠佳的环境中，FETO 与孤立性左侧 CDH 和严重肺发育不全胎儿的新生儿存活率提高相关。版权所有 © 2020 ISUOG。由 John Wiley & Sons Ltd 出版。
