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Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis.
Tho, Adam Lye Wye; Rath, Chandra Prakash; Tan, Jason Khay Ghim; Rao, Shripada C.
Affiliation
  • Tho ALW; Neonatology, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia.
  • Rath CP; Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia.
  • Tan JKG; Neonatology, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia.
  • Rao SC; Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia.
Arch Dis Child Fetal Neonatal Ed ; 109(1): 52-58, 2023 Dec 15.
Article in En | MEDLINE | ID: mdl-37419685
ABSTRACT

BACKGROUND:

Fetoscopic endoluminal tracheal occlusion (FETO) has been shown to improve survival of infants with congenital diaphragmatic hernia (CDH). However, there are concerns that FETO may lead to tracheomegaly, tracheomalacia and related complications.

METHODS:

A systematic review was conducted to estimate the prevalence of symptomatic tracheal complications in infants who underwent FETO for CDH. Presence of one or more of the following was considered as tracheal complication tracheomalacia, stenosis, laceration or tracheomegaly with symptoms such as stridor, effort-induced barking cough, recurrent chest infections or the need for tracheostomy, tracheal suturing, or stenting. Isolated tracheomegaly on imaging or routine bronchoscopy without clinical symptoms was not considered as tracheal morbidity. Statistical analysis was performed using the metaprop command on Stata V.16.0.

RESULTS:

A total of 10 studies (449 infants) were included (6 retrospective cohort, 2 prospective cohort and 2 randomised controlled trials). There were 228 infants who survived to discharge. Prevalence rates of tracheal complications in infants born alive were 6% (95% CI 2% to 12%) and 12% (95% CI 4% to 22%) in those who survived to discharge. The spectrum of severity ranged from relatively mild symptoms such as effort-induced barking cough to the need for tracheostomy/tracheal stenting.

CONCLUSION:

A significant proportion of FETO survivors have symptomatic tracheal morbidities of varying severity. Units that are planning to adopt FETO for managing CDH should consider ongoing surveillance of survivors to enable early identification of upper airway issues. Inventing FETO devices that minimise tracheal injury is needed.
Subject(s)
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Airway Obstruction / Tracheomalacia / Hernias, Diaphragmatic, Congenital Type of study: Clinical_trials / Diagnostic_studies / Prevalence_studies / Risk_factors_studies / Systematic_reviews Limits: Female / Humans / Infant / Pregnancy Language: En Journal: Arch Dis Child Fetal Neonatal Ed Journal subject: PEDIATRIA / PERINATOLOGIA Year: 2023 Document type: Article Affiliation country: Australia

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Airway Obstruction / Tracheomalacia / Hernias, Diaphragmatic, Congenital Type of study: Clinical_trials / Diagnostic_studies / Prevalence_studies / Risk_factors_studies / Systematic_reviews Limits: Female / Humans / Infant / Pregnancy Language: En Journal: Arch Dis Child Fetal Neonatal Ed Journal subject: PEDIATRIA / PERINATOLOGIA Year: 2023 Document type: Article Affiliation country: Australia