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FETO for Late-Diagnosed Severe Congenital Diaphragmatic Hernia (CDH) at Cincinnati Children's with Dr. Beth Rymeski
With Dr. Beth Rymeski · hosted by Dr. Jill Knepprath
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
When the left lobe of the liver is touching the apex of the left chest in left-sided CDH, the entire hemi-liver has herniated into that side of the chest.
The cutoff for severe CDH O/E (observed to expected lung to head ratio) on ultrasound is 25%.
In this case, there was a 42% increase in lung volume between balloon placement and removal (left lung volume increased from 1 mL to 23 mL).
For a C-section delivery less than a week after FETO balloon removal, intubation on support and surfactant administration were performed.
Initial respiratory management included Vyvent (APRV setting), then oscillator, with low dose fentanyl to support blood pressure, eventually returning to Vyvent vent settings.
Extubation at 26 days old is pretty good for a severe CDH.
Discharge at day of life 94 (about three months old) is pretty good for severe CDH.
Tracheal dilation is a very common finding in babies who had tracheal occlusion because the trachea was stretched out during the course of the pregnancy.
Tracheal dilation after FETO is not felt to be clinically impactful in the long run based on follow-up data from kids in Europe.
FETO (fetoscopic endotracheal occlusion) uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth.
Liver herniation is especially harmful for fetal lung development because the liver is a large and mobile organ, unlike the bowels.
Balloon removal after FETO is typically done by week 34.