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Fetal Tracheal Occlusion Improves Neonatal Survival

Fetal endoscopic tracheal occlusion ups survival of infants with congenital diaphragmatic hernia

WEDNESDAY, Dec. 14 (HealthDay News) -- Fetal endoscopic tracheal occlusion (FETO) is associated with improved neonatal survival in severe isolated congenital diaphragmatic hernia (CDH), according to a study published online Dec. 14 in Ultrasound in Obstetrics & Gynecology.

Rodrigo Ruano, M.D., Ph.D., from the Universidade de São Paulo in Brazil, and colleagues investigated whether FETO improves survival in cases of severe isolated CDH. Between 2008 and 2010, patients who had fetuses with severe isolated CDH (lung-to-head ratio < 1.0; liver herniation into thoracic cavity; no additional detectable anomalies) at a similar gestational age were randomly allocated to FETO (20 patients) or standard postnatal management (21 patients). FETO was performed under maternal epidural anesthesia with adjunct fetal intramuscular anesthesia. A tracheal balloon was introduced using ultrasound guidance and fetoscopy between 26 and 30 weeks of gestation, and all FETO cases were delivered by an ex utero intrapartum therapy procedure. Similar post-natal therapy was administered for fetuses from both groups. Survival to 6 months of age was the primary outcome.

The investigators found that patients delivered at a significantly earlier mean gestational age in the FETO group (35.6 ± 2.4 weeks) compared with controls (37.4 ± 1.9 weeks). Fifty percent of infants in the FETO group and 4.8 percent in the control group survived (relative risk [RR], 10.5) in the intention-to-treat analysis. In the received-treatment analysis, 52.6 percent of FETO group infants and 5.3 percent of the control infants survived (RR, 10.0).

"In conclusion, FETO improves infant survival in isolated severe CDH," the authors write.

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