Do FETO CDH survivors need the same follow-up program as non-FETO patients?
Africa Pertierra Cortada1, Jordi Clotet Caba2, Stephanie Hadley3
1Neonatology Department, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu University of Barcelona, Passeig Sant Joan de Déu, 2. 08950, Esplugues de Llobregat, Barcelona, Spain. africa.pertierra@sjd.es.
European Journal of Pediatrics
|May 5, 2023
Summary
Congenital diaphragmatic hernia (CDH) survivors face chronic health issues. Fetoscopic tracheal occlusion (FETO) therapy primarily impacts respiratory outcomes, not other morbidities, necessitating tailored follow-up for severe cases.
Area of Science:
- Pediatric Surgery
- Neonatology
- Pulmonology
Background:
- Congenital diaphragmatic hernia (CDH) survivors experience significant long-term health challenges and disabilities.
- Antenatal fetoscopic endoluminal tracheal occlusion (FETO) improves survival rates for severe CDH cases.
- Limited data exists on the comprehensive follow-up outcomes for CDH patients who have undergone FETO therapy.
Purpose of the Study:
- To compare the 2-year outcomes of CDH infants based on prenatal FETO treatment.
- To identify the relationship between 2-year morbidities and perinatal characteristics in CDH survivors.
- To assess the impact of FETO therapy on specific health outcomes in CDH patients.
Main Methods:
- Retrospective cohort study analyzing 11 years of clinical follow-up data (2006-2017).
- Evaluation of 114 CDH survivors, analyzing prenatal, neonatal, growth, respiratory, and neurological data at 2 years.
- Statistical analysis of factors influencing outcomes, including prematurity, birth weight, and postnatal severity markers.
Main Results:
- Failure to thrive (FTT) affected 24.6%, GERD 22.8%, respiratory problems 28.9%, and neurodevelopmental disabilities 22% of CDH survivors.
- Prematurity and low birth weight (<2500g) correlated with FTT and respiratory issues.
- FETO therapy specifically influenced respiratory morbidity; postnatal severity factors were linked to most outcomes.
Conclusions:
- CDH patients exhibit specific morbidities at 2 years, largely due to lung hypoplasia severity.
- FETO therapy is associated with increased respiratory problems but not other morbidities at 2 years.
- A multidisciplinary follow-up program is crucial, with more intensive monitoring for severe CDH cases, irrespective of prenatal therapy.
