Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia.

Unlabelled: We report our experience in the postnatal management of congenital diaphragmatic hernia (CDH) after fetal endoluminal balloon tracheal occlusion (FETO).

Material And Methods: Out of 19 CDH fetuses diagnosed since December 2005, 13 had a lung-to-head ratio (LHR) < 1.1 (0.86 +/- 0.11) and underwent FETO at a mean gestational age (GA) of 27.9 weeks. The balloon was removed in 3 cases through puncture in EXIT (ex utero intrapartum treatment); there were 3 trans-utero punctures, 3 fetoscopies and 3 balloons deflated spontaneously. One patient died from bleeding during the FETO procedure. Six patients were not subjected to FETO: 3 had a LHR > or = 1.4 and 3 did not come to consultation prenatally.

Results: Twelve babies were born after FETO at 34.9 +/- 1.7 weeks GA; 3 died before surgery from refractory hypoxia. Six needed high frequency oscillatory ventilation (HFOV), and inhaled nitric oxide (NO), one progressing to extracorporeal membrane oxygenation (ECMO), and 3 needed conventional ventilation. CDH was repaired in 9: 2 with direct sutures and 7 with prosthetic patches. Extubation was at median of 5 days (range: 2 - 40), discharge was at 30.4 +/- 16.4 days. Early complications were 1 reherniation and 2 intestinal occlusions. Two patients died after CDH repair: the ECMO case at 15 days, and an infant discharged on oxygen at home, at age 4 months. Of the non-FETO patients, four needed HFOV and NO. CDH repair was performed in 5: 3 had direct repair and 2 had prosthetic patches. Extubation was at 13.4 +/- 12.9 days and discharge was at 43.8 +/- 26.5 days. One patient died before surgery from severe cardiac malformation. Early complications were 1 reherniation and 1 hiatus hernia. Late complication was 1 reherniation at 5 months of life. There was no postoperative mortality. One patient needs oxygen at home.

Conclusion: CDH patients with a poor prognosis undergoing FETO had postnatal outcomes similar to non-prenatally studied cases and good prognosis cases.