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Procedure‐Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta‐Analysis in the FETO Era

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Introduction This study aims to assess the procedure‐related complications and survival following fetoscopic endotracheal occlusion (FETO) for severe congenital diaphragmatic hernia. Materials and Methods A systematic review and meta‐analysis of… Click to show full abstract

Introduction This study aims to assess the procedure‐related complications and survival following fetoscopic endotracheal occlusion (FETO) for severe congenital diaphragmatic hernia. Materials and Methods A systematic review and meta‐analysis of PubMed and Scopus database searching for FETO procedure in severe CDH (lung‐to‐head ratio [LHR] < 1.0 and/or observed/expected LHR < 0.26 and > 1/3 liver herniation) were performed. The relative risk was assessed and 95% confidence interval (CI) calculated. Procedure complications and survival were compared between FETO and randomized controlled trial (RCT) as well as observational case‐control studies. Results A total of 4,807 records were retrieved based on the title and abstracts, and 18 studies were eligible for statistical analysis (1 RCT and 17 observational case‐control studies). Relative risk (95% CI) comparing FETO and controls for premature rupture of membrane, preterm birth < 32 weeks, preterm birth < 37 weeks, survival at 30 days, and survival at 6 months were 1.7 (0.8‐2.4), 7.3 (0.4‐134), 1.8 (0.8‐3.9), 5.8 (1.5‐22.9), and 10.5 (1.5‐74.7), respectively. Mean difference (95% CI) for gestational age at delivery comparing FETO and controls was 1.8 (−3.1 to −0.5). All these outcomes showed a low level of evidence. Conclusion FETO procedure increased the neonatal survival at 30 days and 6 months; however, it presented a higher rate of premature rupture of membrane, preterm birth < 37 weeks, and decreased the gestational age at delivery by 2 weeks. Nonetheless, the level of evidence is low for all these outcomes. We suggested a large international multicenter RCT to prove the real benefits of FETO.

Keywords: complications survival; procedure related; analysis; procedure; related complications; feto

Journal Title: European Journal of Pediatric Surgery
Year Published: 2017

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