Are in-utero interventions justified? – perspective of neonatologists. Part I. Congenital Diaphragmatic Hernia (CDH)

Abstract

Abstract Introduction: In-utero interventions are often perceived by parents as the only hope for their unborn child. Because it is neonatologists who have to deal with a sick newborn and sometimes unrealistic optimism of the parents after delivery, we have taken on the task of reviewing the current knowledge concerning fetal surgeries from the neonatologist’s perspective. In the first of three parts we have analyzed the data for in-utero interventions for CDH. Objective: Our main objective was to evaluate available data and to ascertain whether performing fetal surgeries for CDH is justified. Methods: Review of available literature on the subject of in-utero interventions in the fetuses with CDH was performed. Pubmed and Cochrane library were searched for relevant publications, in particular for randomized controlled trials. Results: In randomized controlled trial (RCT), the in-utero intervention did not improve the outcome. The results of uncontrolled clinical trials suggest that it may be beneficial in cases with severe lung hypoplasia. The RCT testing the efficacy of the procedure performed later in pregnancy in moderately severe cases in currently under way. Conclusions: In-utero interventions might improve survival in a carefully selected group of patients with CDH. However, the evidence to support this claim is not strong, and until more data is available, in-utero interventions for CDH should only be performed in specialized centers as part of controlled clinical trial.