Abstract：
It is debated whether fetal endoscopic tracheal occlusion (FETO) is beneficial to fetuses with congenital diaphragmatic hernia (CDH) and whether FETO has different effects in moderate and severe CDH. We conducted a systematic review and meta-analysis including the latest evidence to assess the overall effects of FETO on clinical outcomes of CDH.
We searched PubMed, EMBASE, The Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Database to retrieve eligible studies published before 8 September 2022. No language or study design restrictions were applied. Studies were included if CDH fetuses underwent FETO surgery and were compared with a cohort that underwent expectant management, with at least one outcome reported. The primary outcomes were mortality at 1, 6 and 12 months after birth, rates of pulmonary hypertension, use of extracorporeal membrane oxygenation (ECMO) and prematurity. Meta-analysis was conducted to obtain pooled odds ratios (ORs) and mean differences. The quality of included studies and pooled evidence was also assessed.
A total of 1187 CDH fetuses from 20 studies were included in the quantitative synthesis. FETO significantly reduced 1-month (OR, 0.56 (95% CI, 0.34-0.93); P = 0.02, number needed to treat (NNT) = 7.67) and 6-month (OR, 0.34 (95% CI, 0.18-0.65); P = 0.0009, NNT = 5.26) CDH mortality (moderate/low quality of evidence). Subgroup analysis suggested that the effects of FETO on the rates of pulmonary hypertension and ECMO usage were significant in severe CDH (low/moderate quality of evidence) but not in moderate CDH (low/very low quality of evidence). FETO was also associated with an increased risk of preterm prelabor rupture of membranes before 37 weeks\' gestation (OR, 4.94 (95% CI, 2.25-10.88); P < 0.0001, number needed to harm (NNH) = 3.13) and preterm birth before 37 weeks (OR, 5.24 (95% CI, 3.33-8.23); P < 0.00001, NNH = 2.79) (high/moderate quality of evidence). However, FETO was not associated with severe complications, such as preterm birth before 32 weeks, placental abruption or chorioamnionitis (very low/low quality of evidence).
FETO is associated with a reduction in mortality, rate of pulmonary hypertension and ECMO usage in severe CDH, while it reduces only the risk of mortality in moderate CDH. Although FETO increases the risk of late prematurity, it does not result in extreme prematurity. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
We searched PubMed, EMBASE, The Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Database to retrieve eligible studies published before 8 September 2022. No language or study design restrictions were applied. Studies were included if CDH fetuses underwent FETO surgery and were compared with a cohort that underwent expectant management, with at least one outcome reported. The primary outcomes were mortality at 1, 6 and 12 months after birth, rates of pulmonary hypertension, use of extracorporeal membrane oxygenation (ECMO) and prematurity. Meta-analysis was conducted to obtain pooled odds ratios (ORs) and mean differences. The quality of included studies and pooled evidence was also assessed.
A total of 1187 CDH fetuses from 20 studies were included in the quantitative synthesis. FETO significantly reduced 1-month (OR, 0.56 (95% CI, 0.34-0.93); P = 0.02, number needed to treat (NNT) = 7.67) and 6-month (OR, 0.34 (95% CI, 0.18-0.65); P = 0.0009, NNT = 5.26) CDH mortality (moderate/low quality of evidence). Subgroup analysis suggested that the effects of FETO on the rates of pulmonary hypertension and ECMO usage were significant in severe CDH (low/moderate quality of evidence) but not in moderate CDH (low/very low quality of evidence). FETO was also associated with an increased risk of preterm prelabor rupture of membranes before 37 weeks\' gestation (OR, 4.94 (95% CI, 2.25-10.88); P < 0.0001, number needed to harm (NNH) = 3.13) and preterm birth before 37 weeks (OR, 5.24 (95% CI, 3.33-8.23); P < 0.00001, NNH = 2.79) (high/moderate quality of evidence). However, FETO was not associated with severe complications, such as preterm birth before 32 weeks, placental abruption or chorioamnionitis (very low/low quality of evidence).
FETO is associated with a reduction in mortality, rate of pulmonary hypertension and ECMO usage in severe CDH, while it reduces only the risk of mortality in moderate CDH. Although FETO increases the risk of late prematurity, it does not result in extreme prematurity. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：胎儿内镜下气管阻塞（FETO）是否对先天性膈疝（CDH）胎儿有益，以及FETO在中重度CDH中是否有不同的作用。我们进行了一项更新的荟萃分析，以评估FETO对CDH临床结局的总体影响。
方法：我们搜索了PubMed，Embase,科克伦图书馆,中国国家知识基础设施，中国科技期刊数据库,万方数据库检索9月8日之前发表的符合条件的研究，2022年，无论学习设计和语言如何。如果CDH胎儿接受了FETO手术而不是期待治疗，至少有一个结果报告，则纳入研究。主要结果是出生后1、6、12个月的死亡率，肺动脉高压（PH）的发生率，体外膜氧合（ECMO）的使用和早产。采用比值比和均值差异进行Meta分析。还评估了纳入研究和汇总证据的质量。
结果：20项研究共1208例CDH胎儿纳入定量合成。FETO显著降低出生后1个月和6个月的CDH死亡率(OR=0.56,95CI=0.34-0.93,P=0.02,NNT=7.67,OR=0.34,95CI=0.18-0.65,P=0.0009,NNT=5.26,“中等”/“低”质量证据)。进一步的亚组分析表明，在重度CDH（“中度”质量证据）中，FETO对PH和ECMO使用率的改善作用尤其显着。但不在中度CDH(“低”质量证据)中。无论重度和中度CDH（“高”/“中等”质量证据），FETO也会导致胎膜早破<37周和早产<37周（OR=4.94，95CI=2.25-10.88，P<0.0001，NNH=3.13和OR=5.24，95CI=3.33-8.23，P<0.00001，NNH=2.79）。然而,FETO没有引起严重的并发症，包括早产<32周，胎盘早剥或绒毛膜羊膜炎（“低”质量证据）。
结论：FETO降低死亡率，严重CDH的PH和ECMO使用率，虽然它仅降低中度CDH的死亡率。尽管FETO总体上增加了晚期早产，它不会导致极端的早熟。本文受版权保护。保留所有权利。
方法：我们搜索了PubMed，Embase,科克伦图书馆,中国国家知识基础设施，中国科技期刊数据库,万方数据库检索9月8日之前发表的符合条件的研究，2022年，无论学习设计和语言如何。如果CDH胎儿接受了FETO手术而不是期待治疗，至少有一个结果报告，则纳入研究。主要结果是出生后1、6、12个月的死亡率，肺动脉高压（PH）的发生率，体外膜氧合（ECMO）的使用和早产。采用比值比和均值差异进行Meta分析。还评估了纳入研究和汇总证据的质量。
结果：20项研究共1208例CDH胎儿纳入定量合成。FETO显著降低出生后1个月和6个月的CDH死亡率(OR=0.56,95CI=0.34-0.93,P=0.02,NNT=7.67,OR=0.34,95CI=0.18-0.65,P=0.0009,NNT=5.26,“中等”/“低”质量证据)。进一步的亚组分析表明，在重度CDH（“中度”质量证据）中，FETO对PH和ECMO使用率的改善作用尤其显着。但不在中度CDH(“低”质量证据)中。无论重度和中度CDH（“高”/“中等”质量证据），FETO也会导致胎膜早破<37周和早产<37周（OR=4.94，95CI=2.25-10.88，P<0.0001，NNH=3.13和OR=5.24，95CI=3.33-8.23，P<0.00001，NNH=2.79）。然而,FETO没有引起严重的并发症，包括早产<32周，胎盘早剥或绒毛膜羊膜炎（“低”质量证据）。
结论：FETO降低死亡率，严重CDH的PH和ECMO使用率，虽然它仅降低中度CDH的死亡率。尽管FETO总体上增加了晚期早产，它不会导致极端的早熟。本文受版权保护。保留所有权利。
