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In Utero Therapy for Congenital Diaphragmatic Hernia
Marisa E Schwab1, Hanmin Lee2, KuoJen Tsao3
1Division of Pediatric Surgery, University of California San Francisco, 550 16th Street, San Francisco, San Francisco, CA 94158, USA; Department of Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Insights
Congenital diaphragmatic hernia (CDH) is a severe defect often diagnosed before birth. Fetal intervention, particularly fetal endoscopic tracheal occlusion, shows promise for improving outcomes in affected fetuses.
Area of Science:
- Medical research
- Fetal medicine
- Surgical innovation
Background:
- Congenital diaphragmatic hernia (CDH) presents a wide spectrum of severity.
- Severe CDH cases are linked to high fetal morbidity and mortality.
- CDH is a significant target for prenatal therapeutic strategies.
Purpose of the Study:
- To review the current literature on prenatal diagnosis of CDH.
- To outline the historical development of fetal interventions for CDH.
- To discuss fetal endoscopic tracheal occlusion (FETO) and its trial results.
Main Methods:
- Literature review of prenatal diagnosis and fetal intervention for CDH.
- Analysis of historical approaches to fetal therapy for CDH.
- Discussion of fetal endoscopic tracheal occlusion techniques and outcomes.
Main Results:
- Prenatal diagnosis of CDH is established, with varying disease spectra.
- Fetal intervention is a viable strategy for severe CDH.
- Tracheal Occlusion To Accelerate Lung growth (TOTAL) trial data provides insights into FETO efficacy.
Conclusions:
- Congenital diaphragmatic hernia management benefits from fetal intervention.
- Fetal endoscopic tracheal occlusion is a developing therapeutic option.
- Future preclinical studies may offer novel directions for CDH treatment.
Abstract:
Congenital diaphragmatic hernia is an anomaly that is often prenatally diagnosed and spans a wide spectrum of disease, with high morbidity and mortality associated with fetuses with severe defects. Congenital diaphragmatic hernia is thus an ideal target for fetal intervention. We review the literature on prenatal diagnosis, describe the history of fetal intervention for congenital diaphragmatic hernia, and discuss fetal endoscopic tracheal occlusion and the Tracheal Occlusion To Accelerate Lung growth trial results. Finally, we present preclinical studies for potential future directions.
