Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Chen, Y.; Xu, Ruoshi; Xie, Xueping; Wang, T.; Yang, Zongming; Chen, Jun

doi:10.1002/uog.26164

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…Contrary to the previously published meta-analysis that included RCTs with mixed left- and right-sided CDHs [ 20 ], our meta-analysis employed the IPD restricted to patients only with left-sided and severe CDH. This is important when providers counsel their patients because the survival rates with FETO compared to expectant management are different between right- and left-sided CDHs; the survival rates for right-sided CDHs and left-sided CDHs are also different [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, two randomized controlled trials (RCTs) suggested the potential benefits of FETO in improving postnatal survival for severe CDH [15,19]. Such results have also been confirmed in two meta-analyses [20,21]. In addition, FETO has been associated with perinatal complications such as preterm delivery and premature rupture of the membranes [22,23].…”

Section: Introductionmentioning

confidence: 89%

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Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Provinciatto,

Barbalho,

Araujo Júnior

et al. 2024

JCM

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Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47–9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76–13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Provinciatto,

Barbalho,

Araujo Júnior

et al. 2024

JCM

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“…Two recently published randomized controlled trials by Deprest et al 2,9 ,. and a subsequent systematic review 3 investigating the effect of FETO on survival‐to‐discharge, showed promising results. However, the studies also showed a clear downside to the intervention: a steep increase in the risk of preterm prelabor rupture of the membranes (PPROM), defined as amniotic sac rupture prior to 37 weeks' gestation and before the onset of labor, in the FETO group compared with the expectant‐care group.…”

Section: Introductionmentioning

confidence: 99%

“…Surviving infants require intensive treatment and suffer from long-term sequelae. Recent evidence showed that fetal endoscopic tracheal occlusion (FETO) is beneficial for fetuses with CDH 2,3 .…”

Section: Introductionmentioning

confidence: 99%

Plugging membranes after fetoscopy in congenital diaphragmatic hernia: early cost‐effectiveness analysis

Janssen¹,

Drongelen²,

Daamen

et al. 2023

Ultrasound in Obstet & Gyne

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Objectives Fetal endoscopic tracheal occlusion (FETO) improves neonatal survival of fetuses with congenital diaphragmatic hernia (CDH). However, FETO also increases the risk of preterm prelabor rupture of membranes (PPROM) and preterm delivery (PTD), as fetal membrane defects after fetoscopy do not heal. To solve this issue, an advanced sealing plug for closing the membrane defect is being developed. Using early‐stage health economic modeling, we aimed to estimate the potential value of this innovative plug in terms of costs and effects, and to determine the properties required for it to become cost‐effective. Methods Early‐stage health economic modeling was applied to the case of performing FETO in women with a singleton pregnancy whose fetus is diagnosed prenatally with CDH. We simulated a cohort of patients using a state‐transition model over a 45‐year time horizon. In our best‐case‐scenario analysis, we compared the current‐care strategy with the perfect‐plug strategy, which reduces the risk of PPROM and PTD by 100%, to determine the maximum quality‐adjusted life years (QALYs) gained and costs saved. Using threshold analysis, we determined the minimum percentage reduction in the risk of PPROM and PTD required for the plug to be considered cost‐effective. The impact of model parameters on outcome was investigated using a sensitivity analysis. Results Our model indicated that a perfect‐plug strategy would yield on average an additional 1.94 QALYs at a cost decrease of €2554 per patient. These values were influenced strongly by the percentage of cases with early PTD (27–34 weeks). Threshold analysis showed that, for €500 per plug, the plug strategy needs a minimum percentage reduction of 1.83% in the risk of PPROM and PTD (i.e. reduction in the risk from 47.50% to 46.63% for PPROM and from 71.50% to 70.19% for PTD) to be cost‐effective. Conclusions Our model‐based approach showed clear potential of the plug strategy when applied in the context of FETO for CDH fetuses, as only a minor reduction in the risk of PPROM and PTD is needed for the plug to be cost‐effective. Its value is expected to be even higher when used in conditions associated with a higher rate of early PTD. Continued investment in research and development of the plug strategy appears to provide value for money. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Abdominal wall muscle weakness outcomes after split abdominal flap repair of large congenital diaphragmatic hernias in newborn

Molino,

Guillen,

Khan

et al. 2024

Pediatr Surg Int

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Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Cited by 5 publications

References 37 publications

Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Plugging membranes after fetoscopy in congenital diaphragmatic hernia: early cost‐effectiveness analysis

Abdominal wall muscle weakness outcomes after split abdominal flap repair of large congenital diaphragmatic hernias in newborn

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