Russo Francesca, Benachi Alexandra, Gratacos Eduard, Zani Augusto, Keijzer Richard, Partridge Emily, Sananes Nicolas, De Coppi Paolo, Aertsen Michael, Nicolaides Kypros H, Deprest Jan
Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.
Clinical Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium.
Prenat Diagn. 2022 Mar;42(3):291-300. doi: 10.1002/pd.6120.
Congenital diaphragmatic hernia can be diagnosed in the prenatal period and its severity can be measured by fetal imaging. There is now level I evidence that, in selected cases, Fetoscopic Endoluminal Tracheal Occlusion with a balloon increases survival to discharge from the neonatal unit as well as the risk for prematurity. Both effects are dependent on the time point of tracheal occlusion. Fetoscopic Endoluminal Tracheal Occlusion may also lead to iatrogenic death when the balloon cannot be timely retrieved. The implementation of the findings from our clinical studies, may also vary based on local conditions. These may be different in terms of available skill set, access to fetal therapy, as well as outcome based on local neonatal management. We encourage prior benchmarking of local outcomes with optimal postnatal management, based on large enough numbers and using identical criteria as in the recent trials. We propose to work further on prenatal prediction methods, and the improvement of fetal intervention. In this manuscript, we describe a research agenda from a fetal medicine perspective. This research should be in parallel with innovation in neonatal and pediatric (surgical) management of this condition.
先天性膈疝可在产前诊断，其严重程度可通过胎儿影像学检查来衡量。目前有一级证据表明，在某些特定病例中，使用球囊进行胎儿内镜下气管阻塞术可提高新生儿从新生儿重症监护病房出院的存活率，但同时也会增加早产风险。这两种影响都取决于气管阻塞的时间点。当球囊无法及时取出时，胎儿内镜下气管阻塞术也可能导致医源性死亡。我们临床研究结果的应用也可能因当地情况而异。这些情况在可用的技能组合、胎儿治疗的可及性以及基于当地新生儿管理的结果方面可能会有所不同。我们鼓励基于足够大的样本量并使用与近期试验相同的标准，对当地采用最佳产后管理的结果进行预先基准测试。我们建议进一步研究产前预测方法，并改进胎儿干预措施。在本手稿中，我们从胎儿医学的角度描述了一个研究议程。这项研究应与针对该病症的新生儿和儿科（外科）管理创新同步进行。
