Researchers from the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) at Children’s Hospital of Philadelphia (CHOP) demonstrated fetoscopic endoluminal tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) may increase risk of prenatal complications and prematurity, but had beneficial health outcomes for most infants. The findings were published in the journal Fetal Diagnosis and Therapy.
CDH is a very severe birth defect in which there is a hole in the developing diaphragm that allows the contents of the abdomen, like the stomach and liver, to come up into the chest. This causes a lack of space for the lungs to grow and develop normally in utero. In severe cases, CDH can lead to serious disease and even death. CHOP offers FETO, a fetal surgery procedure, in select cases of the most severe CDH. The FETO procedure involves placing a balloon in an unborn baby's airway for several weeks, which allows the lungs to grow. A prior, international, multi-center trial showed survival benefit in patients with severe CDH who underwent FETO.
“Our study demonstrates that for patients with the severest form of CDH, treatment before birth can allow the lungs to grow enough for these newborns to survive and thrive,” said K. Taylor Wild, MD, a study author and attending physician in the Division of Neonatology at Children’s Hospital of Philadelphia. “These findings offer hope that FETO can dramatically improve outcomes for our most vulnerable patients.”
In this single center, retrospective cohort study at CHOP, researchers evaluated 466 CDH patients with a prenatal diagnosis of isolated severe left CDH referred to CHOP from September 2016 through January 2023. Of those, 47 patients were deemed eligible with 12 patients undergoing FETO and 35 patients monitored closely without FETO.
In comparing FETO patients to those monitored without FETO, the researchers observed that FETO patients tended to have more severe conditions overall. Specifically, FETO patients were more likely to present with a lower observed-to-expected lung-to-head ratio (O/E LHR), with values of 21.7% compared to 24.9% in patients without surgical intervention. This lower ratio suggests smaller or underdeveloped lungs.
Half of the FETO patients experienced chorioamniotic membrane separation, a condition where protective layers around the baby separate, compared to just one patient in the expectant management group. Most FETO patients (75%) also faced preterm rupture of membranes, in contrast to only four (11.4%) non-FETO patients. Additionally, FETO patients had a lower gestational age at delivery (35 weeks compared to 38.9 weeks for non-FETO patients) and spent more time in the hospital (135 days versus 94.8 days for non-FETO patients).
In terms of postnatal outcomes, FETO patients benefited from fewer treatments with extracorporeal membrane oxygenation (ECMO), a heart-lung bypass intervention that carries significant risk, with only 25% requiring ECMO compared to 60% of non-FETO patients. Additionally, none of the FETO patients needed pulmonary hypertension medications at discharge, in contrast to 28% of non-FETO patients. Overall, FETO patients had a better chance of survival, with a survival rate of 91.7% compared to 71.4% for non-FETO patients.
With FDA support, the research team is broadening FETO eligibility at CHOP, expanding criteria to include severe pulmonary hypoplasia with specific O/E LHR for left CDH (≤30%) and right CDH (≤45%), gestational age between 270 and 296 weeks, normal fetal karyotype, and maternal age of 18 or older. Exclusions include multi-fetal pregnancy, additional fetal anomalies, short cervix, latex allergy, or other conditions precluding surgery. The team plans a formal statistical analysis with a larger sample size.
“We want families to understand that where they seek CDH care can make a difference,” said Holly Hedrick, MD, a lead study author and pediatric and fetal surgeon in CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “High-volume centers with experience in fetal surgery, like CHOP, have an unparalleled experience with the complex medical needs of CDH patients both before and after delivery.”
The research was supported by CHOP’s Clinical Outcomes Data Archive (CODA) team. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Land et al. “Fetoscopic Endoluminal Tracheal Occlusion (FETO) versus Expectant Management for Severe Congenital Diaphragmatic Hernia at a Single Center.” Fetal Diagn Ther. Online July 4, 2025. DOI: 10.1159/000546160.
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Researchers from the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) at Children’s Hospital of Philadelphia (CHOP) demonstrated fetoscopic endoluminal tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) may increase risk of prenatal complications and prematurity, but had beneficial health outcomes for most infants. The findings were published in the journal Fetal Diagnosis and Therapy.
CDH is a very severe birth defect in which there is a hole in the developing diaphragm that allows the contents of the abdomen, like the stomach and liver, to come up into the chest. This causes a lack of space for the lungs to grow and develop normally in utero. In severe cases, CDH can lead to serious disease and even death. CHOP offers FETO, a fetal surgery procedure, in select cases of the most severe CDH. The FETO procedure involves placing a balloon in an unborn baby's airway for several weeks, which allows the lungs to grow. A prior, international, multi-center trial showed survival benefit in patients with severe CDH who underwent FETO.
“Our study demonstrates that for patients with the severest form of CDH, treatment before birth can allow the lungs to grow enough for these newborns to survive and thrive,” said K. Taylor Wild, MD, a study author and attending physician in the Division of Neonatology at Children’s Hospital of Philadelphia. “These findings offer hope that FETO can dramatically improve outcomes for our most vulnerable patients.”
In this single center, retrospective cohort study at CHOP, researchers evaluated 466 CDH patients with a prenatal diagnosis of isolated severe left CDH referred to CHOP from September 2016 through January 2023. Of those, 47 patients were deemed eligible with 12 patients undergoing FETO and 35 patients monitored closely without FETO.
In comparing FETO patients to those monitored without FETO, the researchers observed that FETO patients tended to have more severe conditions overall. Specifically, FETO patients were more likely to present with a lower observed-to-expected lung-to-head ratio (O/E LHR), with values of 21.7% compared to 24.9% in patients without surgical intervention. This lower ratio suggests smaller or underdeveloped lungs.
Half of the FETO patients experienced chorioamniotic membrane separation, a condition where protective layers around the baby separate, compared to just one patient in the expectant management group. Most FETO patients (75%) also faced preterm rupture of membranes, in contrast to only four (11.4%) non-FETO patients. Additionally, FETO patients had a lower gestational age at delivery (35 weeks compared to 38.9 weeks for non-FETO patients) and spent more time in the hospital (135 days versus 94.8 days for non-FETO patients).
In terms of postnatal outcomes, FETO patients benefited from fewer treatments with extracorporeal membrane oxygenation (ECMO), a heart-lung bypass intervention that carries significant risk, with only 25% requiring ECMO compared to 60% of non-FETO patients. Additionally, none of the FETO patients needed pulmonary hypertension medications at discharge, in contrast to 28% of non-FETO patients. Overall, FETO patients had a better chance of survival, with a survival rate of 91.7% compared to 71.4% for non-FETO patients.
With FDA support, the research team is broadening FETO eligibility at CHOP, expanding criteria to include severe pulmonary hypoplasia with specific O/E LHR for left CDH (≤30%) and right CDH (≤45%), gestational age between 270 and 296 weeks, normal fetal karyotype, and maternal age of 18 or older. Exclusions include multi-fetal pregnancy, additional fetal anomalies, short cervix, latex allergy, or other conditions precluding surgery. The team plans a formal statistical analysis with a larger sample size.
“We want families to understand that where they seek CDH care can make a difference,” said Holly Hedrick, MD, a lead study author and pediatric and fetal surgeon in CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “High-volume centers with experience in fetal surgery, like CHOP, have an unparalleled experience with the complex medical needs of CDH patients both before and after delivery.”
The research was supported by CHOP’s Clinical Outcomes Data Archive (CODA) team. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Land et al. “Fetoscopic Endoluminal Tracheal Occlusion (FETO) versus Expectant Management for Severe Congenital Diaphragmatic Hernia at a Single Center.” Fetal Diagn Ther. Online July 4, 2025. DOI: 10.1159/000546160.
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