Abstract：
OBJECTIVE: A recent European randomized trial - Tracheal Occlusion To Accelerate Lung Growth - demonstrated that fetoscopic endoluminal tracheal occlusion (FETO) is associated with increased postnatal survival among infants with severe congenital diaphragmatic hernia (CDH). However, this differs in middle-income countries such as Brazil, where abortion is illegal and neonatal intensive care is inadequate. This study evaluated the effects of FETO on improving the survival of infants with moderate-to-severe CDH in isolated and non-isolated cases.
METHODS: This retrospective cohort study selected 49 fetuses with CDH, a normal karyotype, and a lung-to-head ratio (LHR) of <1 from a single national referral center for fetal surgery in São Paulo, Brazil, between January 2016 and November 2019. FETO was performed between 26 and 29 weeks of gestation. The primary outcomes were infant survival until discharge from the neonatal intensive care unit and survival until six months of age.
RESULTS: Forty-six women with singleton fetuses having severe CDH underwent prenatal intervention with FETO. Infant survival rates until discharge and at six months of age were both 38 %. The observed-to-expected LHR increased by 25 % after FETO in neonates who survived until discharge. Spontaneous intrauterine death occurred in four growth-restricted fetuses after FETO. Preterm birth in <37 weeks and preterm rupture of membranes in <34 weeks occurred in 56.5 % (26) and 26 % (12) cases, respectively.
CONCLUSIONS: FETO may increase neonatal survival in fetuses with severe CDH, particularly in countries with limited neonatal intensive care.
METHODS: This retrospective cohort study selected 49 fetuses with CDH, a normal karyotype, and a lung-to-head ratio (LHR) of <1 from a single national referral center for fetal surgery in São Paulo, Brazil, between January 2016 and November 2019. FETO was performed between 26 and 29 weeks of gestation. The primary outcomes were infant survival until discharge from the neonatal intensive care unit and survival until six months of age.
RESULTS: Forty-six women with singleton fetuses having severe CDH underwent prenatal intervention with FETO. Infant survival rates until discharge and at six months of age were both 38 %. The observed-to-expected LHR increased by 25 % after FETO in neonates who survived until discharge. Spontaneous intrauterine death occurred in four growth-restricted fetuses after FETO. Preterm birth in <37 weeks and preterm rupture of membranes in <34 weeks occurred in 56.5 % (26) and 26 % (12) cases, respectively.
CONCLUSIONS: FETO may increase neonatal survival in fetuses with severe CDH, particularly in countries with limited neonatal intensive care.
摘要：
目的：最近一项欧洲随机试验——气管封堵加速肺生长——证明胎儿内镜下气管腔内封堵(FETO)与重度先天性膈疝(CDH)婴儿的产后存活率增加相关。然而,这在巴西等中等收入国家有所不同，堕胎是非法的，新生儿重症监护不足。这项研究评估了FETO在改善孤立和非孤立病例中中至重度CDH婴儿生存率方面的作用。
方法：这项回顾性队列研究选择了49例患有CDH的胎儿，正常的核型,圣保罗一家全国胎儿手术转诊中心的肺头比（LHR）<1，巴西,2016年1月至2019年11月。FETO在妊娠26至29周之间进行。主要结果是婴儿从新生儿重症监护病房出院之前的存活和六个月大之前的存活。
结果：46名患有重度CDH的单胎女性接受了FETO产前干预。直到出院和六个月大的婴儿生存率均为38％。存活至出院的新生儿在FETO后观察到的预期LHR增加了25％。在FETO后，四个生长受限的胎儿发生了自发性宫内死亡。<37周早产和<34周胎膜早破发生率分别为56.5%(26例)和26%(12例),分别。
结论：FETO可能会增加重度CDH胎儿的新生儿存活率，特别是在新生儿重症监护有限的国家。
方法：这项回顾性队列研究选择了49例患有CDH的胎儿，正常的核型,圣保罗一家全国胎儿手术转诊中心的肺头比（LHR）<1，巴西,2016年1月至2019年11月。FETO在妊娠26至29周之间进行。主要结果是婴儿从新生儿重症监护病房出院之前的存活和六个月大之前的存活。
结果：46名患有重度CDH的单胎女性接受了FETO产前干预。直到出院和六个月大的婴儿生存率均为38％。存活至出院的新生儿在FETO后观察到的预期LHR增加了25％。在FETO后，四个生长受限的胎儿发生了自发性宫内死亡。<37周早产和<34周胎膜早破发生率分别为56.5%(26例)和26%(12例),分别。
结论：FETO可能会增加重度CDH胎儿的新生儿存活率，特别是在新生儿重症监护有限的国家。
