Long-term outcome after fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review
In brief
Long-term survival and neurodevelopment are similar for CDH infants with or without fetal tracheal occlusion
A review of 14 studies involving 395 infants showed that, after adjusting for disease severity, FETO did not improve long-term outcomes compared with standard care; respiratory problems were common but tended to improve, and growth catch-up occurred by age two. The findings highlight persistent multisystem morbidity and the need for ongoing multidisciplinary follow-up.
- Journal
- Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (Q1)
- Published
- 29 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- S Shah, R Ruiz Roman, K H Nicolaides
- PMID
- 42667692
- DOI
- 10.1002/uog.70302
Why clinicians should know about it
- Picked for Epidemiology (paper of the day, 30 August 2026): Systematic review of cohort and RCT outcomes after FETO
Abstract
OBJECTIVE: This systematic review aimed to evaluate the long-term outcomes of infants who had undergone fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH). METHODS: PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to October 2025 for studies reporting infant outcome ≥ 1 year post FETO in the following domains: growth and nutritional, neurodevelopmental, audiological, cardiac, respiratory, gastrointestinal and musculoskeletal. Quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials and the Newcastle-Ottawa scale for cohort studies. Meta-analysis was not performed due to outcome heterogeneity and a narrative synthesis was conducted instead. RESULTS: Fourteen studies (one randomized controlled trial and 13 cohort studies), including a total of 395 infants, were analyzed. The duration of follow-up ranged from 7 to 87 months. Among domains of morbidity, respiratory complications were the most prevalent, although most improved over time. Growth failure affected a significant proportion of infants at 1 year, but considerable catch-up growth was demonstrated by 2 years. Gastrointestinal morbidity was common, with gastroesophageal reflux disease reported in 25-50% of cases and hernia recurrence in 21-43%. Neurodevelopmental outcome was generally reassuring. Multiple studies found no significant differences in long-term outcome between infants that underwent FETO and those that did not after adjusting for disease severity. CONCLUSION: FETO-treated CDH survivors experience substantial but improving multisystem morbidity that may be driven by factors independent of the intervention itself, emphasizing the need for long-term multidisciplinary follow-up. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.