Fetal Tracheal Occlusion for Congenital Diaphragmatic Hernia

This editorial discusses findings from the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial, which evaluated fetoscopic endoluminal tracheal occlusion (FETO) for left-sided congenital diaphragmatic hernia (CDH) with moderate or severe pulmonary hypoplasia. FETO significantly improved survival to NICU discharge in severe cases (40% vs. 15% with expectant care) but showed no benefit in moderate cases. The procedure increased risks of preterm birth and preterm membrane rupture. The author highlights the need for long-term outcome studies, improved FETO techniques, and integration of genetic screening in patient selection. The editorial emphasizes careful parental counseling, recommending FETO only for severe CDH at experienced centers while advocating for further research to optimize outcomes.

This editorial discusses findings from the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial, which evaluated fetoscopic endoluminal tracheal occlusion (FETO) for left-sided congenital diaphragmatic hernia (CDH) with moderate or severe pulmonary hypoplasia. FETO significantly improved survival to NICU discharge in severe cases (40% vs. 15% with expectant care) but showed no benefit in moderate cases. The procedure increased risks of preterm birth and preterm membrane rupture. The author highlights the need for long-term outcome studies, improved FETO techniques, and integration of genetic screening in patient selection. The editorial emphasizes careful parental counseling, recommending FETO only for severe CDH at experienced centers while advocating for further research to optimize outcomes.