Foetoscopic endotracheal occlusion (FETO) for severe isolated left-sided congenital diaphragmatic hernia: single center Polish experience

Abstract

Objective: To present early experience with foetoscopic endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) in a new center in Poland.

Methods: This was a prospective study in singleton pregnancies with CDH treated by FETO between 2014 and 2016 in the Medical University of Warsaw, Poland. FETO was carried out at 25.6–30.1 (median 27.7) weeks’ gestation in 28 consecutive cases of isolated left-sided CDH with observed over expected lung area to head circumference ratio (o/e LHR) of 20.7–22.6 (median 18.9).

Results: Neonatal survival rate was 46.4% (13/28) at the time of discharge. The median o/e LHR the day before balloon removal was 33.4 (19.7–57.5) and median gestational age at delivery was 34.7 (29.0–38.1) weeks. Comparison of the survivors and perinatal deaths showed no significant differences in median gestational age at FETO or median o/e LHR before FETO, but higher median gestational age at delivery (35.9, range 32.7–38.1 weeks vs. 33.2, range 29.0–37.7 weeks; p = .007) and o/e LHR before balloon removal (33.7, range 28.3–57.5 vs. 30.9, range 19.7–37.5; p = .017).

Conclusions: FETO was implemented successfully in Poland and the survival rate (46.4%) is similar to that reported in other centers. Important determinants of survival were gestational age at delivery and pulmonary response to FETO. The rate of preterm prelabor rupture of membranes (PPROM) in our series is similar to the larger series treated with FETO in the pioneering centers of this technique.

Keywords:

• Congenital diaphragmatic hernia
• endotracheal occlusion
• fetoscopy
• lung expansion

Acknowledgements

We are grateful to Professor Kypros Nicolaides of King’s College Hospital, London, UK, for training Przemyslaw Kosinski in fetal medicine and surgery and Professor Jacques Jani of UH Brugmann, Brussels, Belgium for assisting in the first balloon insertion in Poland.

We would also like to give our acknowledgement for engagement and taking care of our patients in the 1st Department of Obstetrics and Gynecology of Medical University of Warsaw: Dorota Bomba-Opon, Katarzyna Luterek, Bozena Kociszewska-Najman, Department of Paediatric Surgery of Medical University of Warsaw: Andrzej Kaminski, Department of Pediatric Anaesthesiology and Intensive Unit of Warsaw Medical University: Magdalena Mierzewska-Schmidt, the Department of Obstetrics and Gynecology and Department of Intensive Care and Congenital Malformations of the Neonates and Infants of Polish Mother’s Memorial Hospital Research Institute in Lódz: Iwona Maroszynska, Jerzy Guzowski, Przemyslaw Oszukowski and many whose names we have failed to mention.

Disclosure statement

No potential conflict of interest was reported by the authors.