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Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis
  1. Adam Lye Wye Tho1,2,
  2. Chandra Prakash Rath1,2,3,
  3. Jason Khay Ghim Tan2,4,
  4. Shripada C Rao2,3
  1. 1 Neonatology, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
  2. 2 Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
  3. 3 Medical School, University of Western Australia, Crawley, Western Australia, Australia
  4. 4 Neonatal Unit, Paediatrics, Joondalup Health Campus, Perth, Western Australia, Australia
  1. Correspondence to Dr Shripada C Rao, Neonatology, Perth Children's Hospital, Nedlands, Western Australia, 6008, Australia; shripada.rao{at}


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.

  • Neonatology
  • Child Health
  • Intensive Care Units, Neonatal

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  • Contributors ALWT and JKGT conceptualised the project. ALWT and CPR performed the literature search, collected data, conducted the risk of bias assessment, interpreted the results and drafted the manuscript. SCR ran the statistics and critically reviewed the manuscript. JKGT reviewed the manuscript. ALWT is responsible for the overall content as the guarantor and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.