Perinatal Outcomes after Fetal Endoscopic Tracheal Occlusion for Isolated Congenital Diaphragmatic Hernia: Rapid Review.

Objective:  To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management.

Data Sources:  In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included.

Study Selection:  We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCT met the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group).

Data Collection:  Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading).

Data Synthesis:  There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6 ±  2.4 weeks in the intervention group, and of 37.4 ±  1.9 weeks among the controls ( < 0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls ( < 0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5-74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls ( = 0.02; relative risk: 0.6; 95%CI: 0.4-0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low.

Conclusion:  Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.