Among fetuses with congenital diaphragmatic hernia, endoscopic tracheal occlusion to induce lung growth doesn't improve survival or morbidity rates, when compared to standard postnatal care. It also increases the likelihood of premature rupture of membranes and preterm delivery, according to a randomized trial.
Researchers randomized 24 women carrying fetuses between 22 and 27 weeks' gestation that had severe, left-sided congenital diaphragmatic hernia to either fetal tracheal occlusion or post-birth repair. Recruitment was halted at 24 patients because of the unexpectedly high 90-day survival rate with standard care (77%) versus 73% with tracheal occlusion.
Neonatal morbidity rates did not differ between the groups, and premature rupture of membranes and preterm delivery were more common in the intervention group than in those receiving postnatal treatment. Because the severity of hernias at randomization was inversely related to survival in both groups, fetuses with lung-to-head ratios of less than 0.9 remain the greatest challenge.
Harrison MR, Keller RL, Hawgood SB, et al. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med. 2003;349:1916-1924.