Prenatal management of congenital diaphragmatic hernia

IF 2.9 3区医学 Q1 PEDIATRICS Seminars in Fetal & Neonatal Medicine Pub Date : 2022-12-01 DOI:10.1016/j.siny.2022.101406

Enrico Danzer , Natalie E. Rintoul , Krisa P. van Meurs , Jan Deprest

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引用次数: 3

Abstract

Recently, two randomized controlled, prospective trials, the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, reported the outcomes on fetal endoluminal tracheal occlusion (FETO) for isolated left congenital diaphragmatic hernia (CDH). FETO significantly improved outcomes for severe hypoplasia. The effect in moderate cases, where the balloon was inserted later in pregnancy, did not reach significance. In a pooled analysis investigating the effect of the heterogeneity of the treatment effect by the time point of occlusion and severity, the difference may be explained by a difference in the duration of occlusion. Nevertheless, FETO carries a significant risk of preterm birth. The primary objective of this review is to provide an overview of the rationale for fetal intervention in CDH and the results of the randomized trials. The secondary objective is to discuss the technical aspects of FETO. Finally, recent developments of potential alternative fetal approaches will be highlighted.

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先天性膈疝的产前处理

最近，两项随机对照前瞻性试验，即气管闭塞加速肺生长(TOTAL)试验，报道了胎儿腔内气管闭塞(FETO)治疗孤立性左侧先天性膈疝(CDH)的结果。FETO显著改善了严重发育不全患者的预后。在中等情况下，在怀孕后期插入球囊，效果没有达到显著性。在一项研究闭塞时间点和严重程度对治疗效果异质性影响的汇总分析中，这种差异可以用闭塞时间的差异来解释。然而，FETO有很大的早产风险。本综述的主要目的是概述胎儿干预CDH的基本原理和随机试验的结果。第二个目标是讨论FETO的技术方面。最后，将强调潜在的替代胎儿方法的最新发展。

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来源期刊

Seminars in Fetal & Neonatal Medicine 医学-小儿科

CiteScore

6.40

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Seminars in Fetal & Neonatal Medicine (formerly Seminars in Neonatology) is a bi-monthly journal which publishes topic-based issues, including current ''Hot Topics'' on the latest advances in fetal and neonatal medicine. The Journal is of interest to obstetricians and maternal-fetal medicine specialists. The Journal commissions review-based content covering current clinical opinion on the care and treatment of the pregnant patient and the neonate and draws on the necessary specialist knowledge, including that of the pediatric pulmonologist, the pediatric infectious disease specialist, the surgeon, as well as the general pediatrician and obstetrician. Each topic-based issue is edited by an authority in their field and contains 8-10 articles. Seminars in Fetal & Neonatal Medicine provides: • Coverage of major developments in neonatal care; • Value to practising neonatologists, consultant and trainee pediatricians, obstetricians, midwives and fetal medicine specialists wishing to extend their knowledge in this field; • Up-to-date information in an attractive and relevant format.

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