Fetal intervention for congenital diaphragmatic hernia

Semin Pediatr Surg. 2019 Aug;28(4):150818. doi: 10.1053/j.sempedsurg.2019.07.001. Epub 2019 Jul 18.


Congenital diaphragmatic hernia (CDH) is a condition that results from incomplete diaphragm formation during embryogenesis. The diaphragmatic defect allows for herniation of abdominal viscera into the chest, and the resulting pulmonary hypoplasia and pulmonary hypertension can lead to cardiorespiratory failure in the neonatal period. There is a wide spectrum of disease severity in CDH, and while advances in neonatal care and the introduction of extracorporeal membrane oxygenation have improved outcomes in many cases, the most severe defects are still associated with high morbidity and mortality. Improvements in prenatal diagnostic and prognostic capabilities have created an opportunity to select high risk patients for fetal intervention. Three decades of refinements in the fetal surgical therapy for CDH have led to the current technique of Fetoscopic Endoluminal Tracheal Occlusion (FETO). Herein, we review the current considerations for selecting patients for fetal intervention, and the contemporary fetal surgical operation for CDH, FETO, with a focus on early outcomes and ongoing studies.

Keywords: Congenital diaphragmatic hernia; Lung to head ratio; Tracheal occlusion.

Publication types

  • Review

MeSH terms

  • Clinical Trials as Topic
  • Female
  • Fetoscopy*
  • Fetus / diagnostic imaging
  • Fetus / surgery*
  • Hernia / diagnostic imaging
  • Hernias, Diaphragmatic, Congenital / complications
  • Hernias, Diaphragmatic, Congenital / diagnostic imaging
  • Hernias, Diaphragmatic, Congenital / surgery*
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / etiology
  • Liver / diagnostic imaging
  • Lung Volume Measurements
  • Magnetic Resonance Imaging
  • Pregnancy
  • Prognosis
  • Severity of Illness Index
  • Ultrasonography, Prenatal