| Autor: |
Provinciatto H; Department of Medicine, Barao de Maua University Center, Ribeirao Preto 14090-062, SP, Brazil., Barbalho ME; Department of Medicine, Potiguar University, Natal 59056-000, RN, Brazil., Araujo Júnior E; Department of Obstetrics, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo 04023-062, SP, Brazil., Cruz-Martínez R; Fetal Medicine Mexico Institute, Guadalajara 45606, Jalisco, Mexico., Agrawal P; Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA., Tonni G; Department of Obstetrics and Neonatology, and, Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda USL Reggio Emilia, 42122 Reggio Emilia, Italy., Ruano R; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite # 1152, Miami, FL 33136, USA. |
| Abstrakt: |
Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47-9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76-13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention. |
