15 Participants Needed

Fetal Surgery for Congenital Diaphragmatic Hernia

(FETO Trial)

Recruiting at 1 trial location
MC
KE
Overseen ByKatie E Boyle, MPH
Age: 18+
Sex: Female
Trial Phase: Academic
Sponsor: Connecticut Children's Medical Center
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Approved in 2 JurisdictionsThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

The rationale for fetal therapy in severe congenital diaphragmatic hernia (CDH) is to restore adequate lung growth for neonatal survival.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Fetoscopic Endoluminal Tracheal Occlusion (FETO) for congenital diaphragmatic hernia?

Research shows that FETO can improve the survival of infants with severe congenital diaphragmatic hernia by promoting lung growth and development, although it may lead to complications like tracheomegaly (enlarged trachea) and tracheomalacia (softening of the trachea).12345

Is FETO generally safe for humans?

Fetoscopic Endoluminal Tracheal Occlusion (FETO) is a treatment that can help babies with severe congenital diaphragmatic hernia, but it may lead to complications like tracheomegaly (enlarged windpipe) and tracheomalacia (softening of the windpipe). There are also concerns about preterm delivery (early birth) as a result of the procedure.12456

How is the FETO treatment different from other treatments for congenital diaphragmatic hernia?

FETO is a unique treatment for congenital diaphragmatic hernia because it involves a minimally invasive procedure where a balloon is placed in the fetus's trachea (windpipe) to help the lungs develop better before birth. This approach is different from traditional treatments that usually occur after birth and focus on surgical repair of the diaphragm.24578

Research Team

TC

Timothy Crombleholme, MD

Principal Investigator

Connecticut Children's Medical Center

Eligibility Criteria

This trial is for pregnant women aged 18 or older with a single pregnancy and a fetus diagnosed with severe left-sided Congenital Diaphragmatic Hernia (CDH) where the liver has moved up into the chest. The baby must have significant lung underdevelopment, confirmed by ultrasound before 29 weeks + 6 days of gestation, and a normal karyotype.

Inclusion Criteria

I am a pregnant woman, 18 or older, and can give consent.
My unborn baby has been diagnosed with a left-sided CDH and the liver is positioned upwards.
Gestation at enrollment prior to 29 wks plus 6 days
See 3 more

Exclusion Criteria

I am pregnant and under 18.
My diaphragmatic hernia is right-sided, bilateral, or a severe left-sided with specific lung-to-head ratio.
I cannot have surgery using a scope due to technical reasons.
See 5 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Fetoscopic Endoluminal Tracheal Occlusion (FETO) procedure is performed to promote lung growth in fetuses with severe left congenital diaphragmatic hernia

2 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment, including postnatal mechanical ventilator support

4 weeks

Treatment Details

Interventions

  • Fetoscopic Endoluminal Tracheal Occlusion (FETO)
Trial OverviewThe trial is testing Fetoscopic Endoluminal Tracheal Occlusion (FETO), which is a prenatal surgery aiming to improve lung growth in fetuses with severe CDH by temporarily blocking their trachea.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Fetoscopic Endoluminal Tracheal Occlusion (FETO)Experimental Treatment1 Intervention
An un-blinded non-randomized single arm pilot study of FETO in fetuses with congenital diaphragmatic hernia (CDH)

Fetoscopic Endoluminal Tracheal Occlusion (FETO) is already approved in United States, European Union for the following indications:

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Approved in United States as FETO for:
  • Severe congenital diaphragmatic hernia (CDH)
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Approved in European Union as FETO for:
  • Severe congenital diaphragmatic hernia (CDH)

Find a Clinic Near You

Who Is Running the Clinical Trial?

Connecticut Children's Medical Center

Lead Sponsor

Trials
76
Recruited
30,000+

Medical City Children's Hospital

Lead Sponsor

Trials
3
Recruited
60+

Findings from Research

Fetal endoscopic tracheal occlusion (FETO) is a treatment for severe congenital diaphragmatic hernia that can lead to complications such as tracheomegaly in infants, as observed in a series of five cases.
This study highlights a new potential risk associated with FETO, suggesting that the compliant fetal airway may be damaged by balloon occlusion, warranting careful evaluation of the trachea in infants who underwent this procedure.
Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia.McHugh, K., Afaq, A., Broderick, N., et al.[2021]
A systematic review of 10 studies involving 449 infants who underwent fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) found that 6% of infants born alive and 12% of those who survived to discharge experienced symptomatic tracheal complications.
These complications ranged from mild symptoms like barking cough to severe issues requiring tracheostomy, highlighting the need for ongoing monitoring of FETO survivors and the development of devices that reduce tracheal injury.
Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis.Tho, ALW., Rath, CP., Tan, JKG., et al.[2023]
In a trial involving 196 women, fetoscopic endoluminal tracheal occlusion (FETO) did not show a significant improvement in survival rates for infants with moderate congenital diaphragmatic hernia compared to expectant care, with 63% survival in the FETO group versus 50% in the control group (P=0.06).
FETO was associated with higher risks of preterm birth and prelabor rupture of membranes (44% vs. 12% and 64% vs. 22%, respectively), indicating potential safety concerns despite no serious maternal complications reported.
Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia.Deprest, JA., Benachi, A., Gratacos, E., et al.[2022]

References

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia. [2021]
Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis. [2023]
Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. [2022]
Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience. [2020]
Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. [2022]
A novel translational model of percutaneous fetoscopic endoluminal tracheal occlusion - baboons (Papio spp.). [2021]
Clinically relevant discordances identified after tertiary reassessment of fetuses with isolated congenital diaphragmatic hernia. [2022]
Morbidity in children after fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: Results from a multidisciplinary clinic. [2023]