Perinatal Outcomes after Fetal Endoscopic Tracheal Occlusion for Isolated Congenital Diaphragmatic Hernia: Rapid Review

Abstract Objective To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management. Data sources In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included. Study selection We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCTmet the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group). Data collection Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading). Data synthesis There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6±2.4 weeks in the intervention group, and of 37.4±1.9 weeks among the controls (p<0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls (p<0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5-74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls (p=0.02; relative risk: 0.6; 95%CI: 0.4-0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low. Conclusion Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.

摘要

## 目的
对比孤立性先天性膈疝（isolated congenital diaphragmatic hernia）胎儿接受胎儿内镜下气管封堵术（FETO，fetal endoscopic tracheal occlusion）与产前期待治疗后的围产期结局。

## 数据来源
本快速综述于2020年8月10日至9月4日期间，在MEDLINE、PMC、EMBASE及CENTRAL数据库中开展检索。纳入近10年以英文发表的随机对照试验（randomized controlled trial, RCT）、类随机对照试验（quasi-RCT）或整群随机对照试验（cluster-RCT）。

## 研究筛选
本次检索共获取203篇文献，通过摘要初筛排除180项研究；对余下8项研究开展全文筛选，最终仅1项单中心随机对照试验符合纳入标准，共纳入41名随机分组的孕妇，其中FETO组20例，对照组21例。

## 数据收集
由两名研究者独立分两步开展数据收集：首先进行标题与摘要筛选，随后完成全文阅读。

## 数据综合
本研究未出现孕产妇死亡病例。干预组产妇分娩时的平均孕周为35.6±2.4周，对照组为37.4±1.9周（p<0.01）。干预组婴儿6月龄存活率为50%，对照组为5.8%（p<0.01；相对危险度（relative risk, RR）：10.5；95%置信区间（95% confidence interval, 95%CI）：1.5~74.7）。干预组婴儿中50%出现严重产后肺动脉高压，对照组为85.7%（p=0.02；相对危险度：0.6；95%CI：0.4~0.9）。本研究存在一定偏倚风险隐患，证据质量被评估为中低等级。

## 结论
现有证据虽有限，但提示胎儿内镜下气管封堵术（FETO）或可作为改善围产期结局的有效干预手段。