Early Childhood Outcomes in Severe Congenital Diaphragmatic Hernia Treated with Fetoscopic Endoluminal Tracheal Occlusion (FETO) versus Non-FETO at a Single Center

Abstract

Introduction: Fetoscopic endoluminal tracheal occlusion (FETO) has demonstrated neonatal survival and pulmonary hypertension (PH) benefits in patients with severe congenital diaphragmatic hernia (CDH). This study describes early childhood outcomes of patients treated with FETO compared to a contemporary cohort of non-FETO patients. Methods: A single center, retrospective cohort study evaluated patients with a prenatal diagnosis of isolated severe left CDH at a single center from September 2016 through January 2023. Severe CDH was defined as liver herniation with an ultrasound observed/expected lung-to-head ratio <30%. Outcomes were assessed by specialists within a multidisciplinary follow-up clinic and are reported as descriptive statistics. Results: Twelve patients underwent FETO and 35 did not (non-FETO). Ninety-one percent of FETO and 75% of non-FETO patients survived to 24 months of age. Among surviving patients, 100% of FETO and 72% of non-FETO patients had a 24-month clinic follow-up assessment. At that time, 45% of FETO patients and 33% of non-FETO patients were feeding exclusively by mouth. Nine percent of FETO and 22% of non-FETO patients required respiratory support. No FETO patients required PH medications, while 22% of non-FETO patients required PH medications. Eighty-three percent and 57% of surviving FETO and non-FETO patients, respectively, had at least one neurodevelopment assessment during the 6-, 12-, or 24-month time points. Despite higher frequency of prematurity among FETO patients, similar neurodevelopmental scores were observed in both groups. Conclusions: FETO patients received PH medications less frequently and had similar outcomes in feeding, respiratory management, and neurodevelopment as non-FETO patients.