Fetal therapy expert, Ahmet Baschat, M.D., M.B. B.CH. B.A.O., discusses latest research on fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia. Research publication:
DOI: 10.1016/j.jpedsurg.2022.05.011 congenital diaphragmatic hernia is a birth defect that results from incomplete formation of the diaphragm, which allows intra thoracic herniation and displacement of abdominal contents, which then compete with the lungs and for space and result in lung compression and impaired lung development. The treatment of congenital diaphragmatic hernia is basically surgical closure after the baby is born. However, in babies with severe diaphragmatic hernia, the lungs may be damaged to the degree that survival is not possible. Despite successful surgical repair Patients where the lungs are compressed to approximately 30% of the expected size are candidates for fetal therapy. And fetal therapy consists of telescopic curricula occlusion that leads to blockage of tracheal fluid, egress and performed around 27 weeks, which leads to lung expansion Um in the 5-6 weeks following and after balloon removal, the lungs are allowed to mature until delivery and then the babies are undergoing post natal surgical closure. So what we were interested to find out is whether the collaboration between a fetal therapy and the pediatric surgical program has an impact of survival. So, in the recent randomized trial that was published in the new England Journal, The care setting. How fetal was offered was basically that there were 10 to 12 fetal therapy centers that had expertise to manage photo, but the post natal care happened at March, large number of pediatric centers. So what we distinguished was a care center or care setting. We're both programs worked hand in hand integrated in one program versus a non integrated care setting, where fetal therapy was performed in one center and then babies delivered elsewhere when managed a variety of programs, and what our systematic review focused on was survival after balloon placement. And what we were able to demonstrate is that in an integrated care setting, the survival is far higher than a non integrated care setting. And in fact, the benefits of survival that have been demonstrated for the balloon are in fact confined to those programs where fetal therapy program and the pediatric surgical program work hand in hand, and there's integrated care transition from prenatal to postnatal life, which is really the optimal care setting, especially for babies with severe diaphragmatic hernia. That without this care have a very low chance of survival.