What is fetoscopic endoluminal tracheal occlusion (FETO)?

Fetoscopic endoluminal tracheal occlusion (FETO) is a fetal surgery procedure that may improve outcomes in babies with severe cases of congenital diaphragmatic hernia (CDH). CDH is a birth defect characterized by the development, very early in gestation, of a hole in the diaphragm, the breathing muscle that separates the chest from the abdomen. As a result, the intestines and other organs in the abdomen can move into the chest and press on the developing lungs. This prevents the lungs from growing and developing normally. In severe cases, CDH can lead to serious disease and death at birth. For these babies, treatment before birth may allow the lungs to grow enough before birth so these children are capable of surviving and thriving. Children’s Hospital of Philadelphia (CHOP) offers FETO as a treatment option to select fetuses with severe CDH. View this video with a transcript

Evaluation for fetal surgery for CDH

Before determining the best course of treatment for your baby, you will undergo a standard prenatal evaluation at CHOP to find out if you are a candidate for fetal surgery. Your evaluation will include: Medical history and physical exam

Level II ultrasound

Fetal echocardiogram

Fetal magnetic resonance imaging (MRI)

Psychosocial evaluation (For healthcare professionals: find additional details about referral guidelines.)

What to expect during the FETO procedure

If you are a candidate for the FETO procedure and decide to pursue fetal surgery, you and your unborn baby will undergo two procedures: Several weeks later, the balloon will be removed from your unborn baby’s airway in order for her lungs to mature. Delivery will be planned in the Garbose Family Special Delivery Unit (SDU). After your baby is born, she will be stabilized in the Newborn/Infant Intensive Care Unit (N/IICU). Once stabilized, she will undergo surgery to repair the hole in her diaphragm. While the balloon is in place, the fetal airway is blocked. Unexpected delivery will be life-threatening if the proper systems are not in place to manage your baby’s airway. As a result, mothers must remain near our fetal center, under close supervision, from the time of balloon placement through delivery in the SDU and discharge from our N/IICU.

Follow-up care after prenatal CDH surgery

Children who undergo FETO to prenatally treat severe CDH will be followed through 2 years of age and then long-term in the Pulmonary Hypoplasia Program at CHOP. You and your child will return to CHOP when your child is 6 months old and again at 12 months and 24 months for routine clinical care visits and developmental evaluations. At all visits the following assessments are performed: Overall general surgical evaluation

Hearing evaluation

Heart evaluation

Lung evaluation

Development evaluation

Overall medical evaluation A pediatric chest X-ray is performed at the 12- and 24-month visits.

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