Long-term outcome after fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review.
S Shah, R Ruiz Roman, K H Nicolaides
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In 30 seconds
This systematic review assessed long-term outcomes after fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH). It included 14 studies—one randomized controlled trial and 13 cohort studies—with 395 infants followed for 7 to 87 months; heterogeneous outcomes were synthesized narratively rather than pooled. Respiratory complications were the most prevalent morbidity, generally improving over time. Gastroesophageal reflux disease was reported in 25-50% of cases and hernia recurrence in 21-43%. Neurodevelopment was generally reassuring, and several studies found no significant adjusted long-term outcome differences between FETO-treated and untreated infants.
Key findings
- Respiratory complications were the most prevalent morbidity, although most improved over time.
- Gastroesophageal reflux disease was reported in 25-50% of cases; hernia recurrence occurred in 21-43%.
- Growth failure affected a significant proportion at 1 year, with considerable catch-up growth by 2 years.
- Neurodevelopmental outcomes were generally reassuring; several studies found no significant adjusted differences between FETO-treated and untreated infants.
Why it matters
Survival after FETO for CDH may be accompanied by substantial morbidity across multiple systems, even as some complications improve and growth catches up. These findings help frame longer-term expectations beyond the fetal intervention and highlight that outcomes may reflect factors beyond FETO itself. Awareness of respiratory, gastrointestinal, growth, and developmental outcomes is relevant to planning ongoing care for survivors.
What to keep in mind
The review included only 14 studies, with follow-up ranging from 7 to 87 months and heterogeneous outcomes that precluded meta-analysis. Most included studies were cohorts.