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Prenatal management of congenital diaphragmatic hernia

  • Enrico Danzer
    Correspondence
    Corresponding author. Division of Pediatric Surgery Memorial Sloan Kettering Cancer Center Weill Cornell Medical College, 1275 York Avenue, H-1315 New York, NY, 10065, USA, Tel.: +1(212) 639-7966; fax: +1(212) 717-3373,
    Affiliations
    Stanford University School of Medicine and Lucile Packard Children’s Hospital, Division of Neonatal and Developmental Medicine, Palo Alto, California, USA

    Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
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  • Natalie E. Rintoul
    Affiliations
    The Richard Wood Jr. Center for Fetal Diagnosis and Treatment and Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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  • Krisa P. van Meurs
    Affiliations
    Stanford University School of Medicine and Lucile Packard Children’s Hospital, Division of Neonatal and Developmental Medicine, Palo Alto, California, USA
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  • Jan Deprest
    Affiliations
    Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

    Center for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

    Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium

    Institute of Women’s Health, University College London Hospitals, London, United Kingdom
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Published:November 17, 2022DOI:https://doi.org/10.1016/j.siny.2022.101406

      Abstract

      Recently, two randomized controlled, prospective trials, the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, reported the outcomes on fetal endoluminal tracheal occlusion (FETO) for isolated left congenital diaphragmatic hernia (CDH). FETO significantly improved outcomes for severe hypoplasia. The effect in moderate cases, where the balloon was inserted later in pregnancy, did not reach significance. In a pooled analysis investigating the effect of the heterogeneity of the treatment effect by the time point of occlusion and severity, the difference may be explained by a difference in the duration of occlusion. Nevertheless, FETO carries a significant risk of preterm birth. The primary objective of this review is to provide an overview of the rationale for fetal intervention in CDH and the results of the randomized trials. The secondary objective is to discuss the technical aspects of FETO. Finally, recent developments of potential alternative fetal approaches will be highlighted.

      Keywords

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