51 - Fetoscopic endoluminal tracheal occlusion (FETO) versus expectant care of severe left-diaphragmatic hernia in North America

Friday, February 10, 2023

1:30 PM – 1:45 PM

Location: Room 3022, Moscone West, Level 3

Objective: To compare outcomes of a contemporaneous cohort of left-sided severe congenital diaphragmatic hernia (L-CDH) managed expectantly and by FETO under a shared protocol in a North American cohort.

Study Design: Data from the North American Fetal Therapy Network (NAFTNet) FETO Consortium consisting of 10 fetal therapy centers with experienced postnatal CDH programs were collected for patients with prenatally diagnosed L-CDH with ultrasound measured observed to expected lung ratio < 25% (O/E-LHR). Infant survival at 6 months was the primary outcome compared between FETO and expectantly managed cohorts. Secondary outcomes included FETO procedure-related morbidity, maternal delivery outcomes and neonatal morbidity.

Results:

Between January 2010 and December 2020, 61of 98 eligible patients (62%) underwent FETO and 37 (38%) had expectant management. Patients undergoing FETO had lower BMI than the expectant group (27.4 vs 30.9 kg/m²p = 0.02) and the O/E LHR assessment technique differed between groups (p < 0.001). Six-month survival in patients who underwent FETO versus expectant management was similar (70% vs 65%, p=0.72). FETO led to higher rates of preterm premature rupture of membranes (PPROM) (54% vs 16%, p=0.001), earlier delivery (mean 35.5 vs 37.9 weeks, p< 0.001) and infants had lower birthweight (mean 2483.9g vs 2915.4g, p< 0.001). FETO patients had comparable surgical disease but earlier neonatal repair than the expectantly managed group (mean day of life 10.6d vs 17.8d, p=0.006). Among survivors at six-months, there was no difference in additional measures including age at discharge, rates of intraventricular hemorrhage, sepsis, necrotizing enterocolitis, or periventricular leukomalacia.

Conclusion: In centers with high survival for severe L-CDH with standard postnatal treatment FETO does not lead to significantly increased six-month survival potentially due to increased rates of PPROM, earlier gestational age at delivery and lower birthweight. The role of FETO in the ongoing care of CDH in North America requires further study.

Primary & Presenting Author(s)

Eric P. Bergh, MD

Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States

Slides

Coauthor(s)

Ahmet A. Baschat, MBBCH, MD (he/him/his)

Director
Johns Hopkins Center for Fetal Therapy
Baltimore, Maryland, United States
HH

Holly Hedrick, MD

Center for Fetal Research
Philadelphia, Pennsylvania, United States
FL

Foong Yen Lim, MD

Cincinnati Children's Hospital Medical Center
Cincinnati, OH, United States
KM

Kevin Magee, MD

Medical City Dallas
Dallas, TX, United States
Greg Ryan, MB

Head, Fetal Medicine program & Ontario Fetal Centre
Mount Sinai Hospital, University of Toronto
Toronto, ON, Canada
Magda Sanz Cortes, MD, PhD (she/her/hers)

Associate Professor in the Department of Obstetrics and Gynecology, Baylor College of Medicine
Baylor College of Medicine
Houston, Texas, United States
Mauro Schenone, MD (he/him/his)

Division Chair, Maternal Fetal Medicine
Mayo Clinic
Rochester, Minnesota, United States
Michael V. Zaretsky, MD (he/him/his)

Associate Professor, Department of OB/GYN
Colorado Fetal Care Center
Aurora, Colorado, United States
Anthony Johnson, DO

Professor
Division of Fetal Intervention, The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States