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Prenatal Interventions: Is FETO Right for Your Baby?

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FETO is a specialized prenatal procedure for severe congenital diaphragmatic hernia (CDH). It involves placing a temporary balloon in the baby's windpipe to help the lungs grow before birth. While it can improve survival chances, it carries significant risks like premature birth.

Key Takeaways

  • • FETO is a specialized prenatal intervention that uses a tiny balloon to temporarily block a baby's windpipe, forcing their lungs to expand and grow before birth.
  • • The procedure is primarily recommended for the most severe cases of isolated left-sided CDH, particularly when the lung-to-head ratio is less than 25%.
  • • The balloon must be removed before birth so the baby can breathe, requiring mothers to relocate near a specialized fetal center.
  • • The most common complication of FETO is your water breaking early (PPROM), which increases the likelihood of a premature delivery.

If your baby has been diagnosed with a severe case of CDH, your doctors may discuss a specialized prenatal intervention called FETO (Fetoscopic Endoluminal Tracheal Occlusion). This procedure is designed to help the lungs grow while the baby is still in the womb, potentially improving their chances of survival after birth [1][2].

How FETO Works

During normal fetal development, the lungs produce a fluid that the baby “breathes” out into the amniotic fluid. In a baby with CDH, the abdominal organs in the chest prevent the lungs from expanding.

FETO uses a tiny balloon to temporarily block the baby’s trachea (windpipe) [3].

  • The Goal: By blocking the windpipe, the natural fluid produced by the lungs is trapped inside. This creates internal pressure that forces the lungs to expand and grow, essentially “stretching” them from the inside out [3][4].
  • The Result: Increased lung volume may make the lungs more capable of taking in oxygen once the baby is born [5].

Who Qualifies for FETO?

FETO is a highly specialized procedure and is generally reserved for the most severe cases of isolated left-sided CDH [1][6].

  • Severity: It is most often recommended when the O/E LHR (lung-to-head ratio) is less than 25% and the liver is in the “up” position [6][1].
  • Moderate CDH: Recent clinical trials (like the TOTAL trial) have shown that FETO does not provide a significant survival benefit for babies with “moderate” CDH compared to standard care [7][8].

The FETO Timeline and Critical Risks

If you decide to proceed with FETO, it involves two main stages. It is crucial to understand that while the balloon is in place, the baby’s airway is completely blocked.

  1. Balloon Insertion: A surgeon uses a small scope to place the balloon in the baby’s trachea, usually around 27 to 29 weeks of pregnancy [1][9].
  2. Balloon Removal: The balloon must be removed before birth so the baby can breathe. Because of this life-or-death risk, mothers are usually required to live very close to the specialized fetal hospital during the weeks the balloon is in place [1][10]. If labor begins early or your water breaks, emergency protocols must be activated immediately to remove the balloon.

Understanding Other Risks

While FETO can significantly improve survival in severe cases, it is an invasive procedure with real risks that parents must consider [11][12].

  • PPROM: This stands for Preterm Prelabor Rupture of Membranes, or your “water breaking” too early. This is the most common complication of FETO [11][13].
  • Premature Birth: Because of the risk of PPROM, babies who have the FETO procedure are more likely to be born early (before 37 weeks) [11][12].

FETO is an investigational intervention performed only at high-volume fetal surgery centers. Your team will help you weigh the potential for improved lung growth against the risks of a premature delivery and the logistics of staying near the hospital [11][9].

Frequently Asked Questions

What is the FETO procedure for CDH?
FETO involves placing a tiny balloon in your baby's windpipe while they are still in the womb. This traps fluid in the lungs, creating pressure that stretches them from the inside and helps them grow and expand before birth.
Who is a candidate for FETO surgery?
FETO is highly specialized and is generally recommended only for the most severe cases of isolated left-sided CDH. Your doctor will evaluate the size of your baby's lungs and the position of their liver to determine if this procedure is appropriate for your pregnancy.
What happens if my water breaks while the FETO balloon is in place?
If your water breaks or labor begins early, emergency protocols must be activated immediately to remove the balloon so your baby can breathe at birth. Because of this critical risk, mothers are usually required to live very close to the specialized hospital while the balloon is in place.
Does FETO help babies with moderate CDH?
Recent clinical trials have shown that FETO does not provide a significant survival benefit for babies diagnosed with moderate CDH when compared to standard care. It is currently reserved for cases deemed severe.

Questions for Your Doctor

  • • Based on our O/E LHR and liver position, does our baby meet the 'severe' criteria for FETO?
  • • What is your center's success rate for survival to discharge after the FETO procedure?
  • • How many FETO procedures does this hospital perform each year, and what is your protocol for balloon removal?
  • • What is the backup plan if my water breaks or I go into labor while the balloon is still in place?
  • • Can you walk me through the specific maternal risks I should be aware of before we decide?
  • • How will this procedure change our plans for delivery and the NICU stay?

Questions for You

  • • Am I emotionally and physically prepared for the possibility of a premature delivery?
  • • Do we have the support system in place to relocate or stay near the fetal center for several weeks?
  • • How do we feel about the trade-off between the potential survival benefit and the risk of procedure-related complications?
  • • Have we had enough time to discuss the options with our family and our care team to feel confident in our decision?

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References

  1. 1

    Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia.

    Deprest JA, Nicolaides KH, Benachi A, et al.

    The New England journal of medicine 2021; (385(2)):107-118 doi:10.1056/NEJMoa2027030.

    PMID: 34106556
  2. 2

    Fetal Tracheal Occlusion for Severe Pulmonary Hypoplasia in Isolated Congenital Diaphragmatic Hernia: A Systematic Review and Meta-analysis of Survival.

    Al-Maary J, Eastwood MP, Russo FM, et al.

    Annals of surgery 2016; (264(6)):929-933 doi:10.1097/SLA.0000000000001675.

    PMID: 26910202
  3. 3

    Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis.

    Provinciatto H, Barbalho ME, Araujo Júnior E, et al.

    Journal of clinical medicine 2024; (13(12)) doi:10.3390/jcm13123572.

    PMID: 38930102
  4. 4

    Characterization of Suboptimal Responses to Fetoscopic Endoluminal Tracheal Occlusion in Congenital Diaphragmatic Hernia.

    Espinoza J, King A, Shamshirsaz AA, et al.

    Fetal diagnosis and therapy 2023; (50(2)):128-135 doi:10.1159/000530549.

    PMID: 37040717
  5. 5

    The Outcomes and Lung Changes of Fetoscopic Endoluminal Tracheal Occlusion in Fetus with Diaphragmatic Hernia: A Single-Center Experience in Japan.

    Muromoto J, Ozawa K, Sugibayashi R, et al.

    Fetal diagnosis and therapy 2026; (53(1)):78-88 doi:10.1159/000548340.

    PMID: 40920601
  6. 6

    Fetal therapy for congenital diaphragmatic hernia: past, present and future.

    Abbasi N, Mieghem TV, Ryan G

    World journal of pediatric surgery 2024; (7(3)):e000835 doi:10.1136/wjps-2024-000835.

    PMID: 40521377
  7. 7

    Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia.

    Deprest JA, Benachi A, Gratacos E, et al.

    The New England journal of medicine 2021; (385(2)):119-129 doi:10.1056/NEJMoa2026983.

    PMID: 34106555
  8. 8

    Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia.

    Cruz-Martínez R, Shazly S, Martínez-Rodríguez M, et al.

    Prenatal diagnosis 2022; (42(3)):310-317 doi:10.1002/pd.5988.

    PMID: 34132402
  9. 9

    The Delivery Room Resuscitation of Infants with Congenital Diaphragmatic Hernia Treated with Fetoscopic Endoluminal Tracheal Occlusion: Beyond the Balloon.

    Wild KT, Rintoul NE, Ades AM, et al.

    Fetal diagnosis and therapy 2024; (51(2)):184-190 doi:10.1159/000536209.

    PMID: 38198774
  10. 10

    How should fetal surgery for congenital diaphragmatic hernia be implemented in the post-TOTAL trial era: A discussion.

    Deprest J, Flake A

    Prenatal diagnosis 2022; (42(3)):301-309 doi:10.1002/pd.6091.

    PMID: 35032132
  11. 11

    Fetal endoscopic tracheal occlusion for moderate and severe congenital diaphragmatic hernia: a systematic review and meta-analysis of randomized controlled trials.

    Li Q, Liu S, Ma X, Yu J

    Pediatric surgery international 2022; (38(9)):1217-1226 doi:10.1007/s00383-022-05170-7.

    PMID: 35838786
  12. 12

    Procedure-Related Complications and Survival Following Fetoscopic Endotracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia: Systematic Review and Meta-Analysis in the FETO Era.

    Araujo Júnior E, Tonni G, Martins WP, Ruano R

    European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie 2017; (27(4)):297-305 doi:10.1055/s-0036-1587331.

    PMID: 27522127
  13. 13

    Fetoscopic Endoluminal Tracheal Occlusion versus Expectant Management for Severe Congenital Diaphragmatic Hernia at a Single Center.

    Land S, Flohr S, Mathew L, et al.

    Fetal diagnosis and therapy 2025; (52(6)):632-643 doi:10.1159/000546160.

    PMID: 40618726

This page provides educational information about the FETO procedure for severe CDH. It is not medical advice; always consult your maternal-fetal medicine specialist to determine the best treatment plan for your pregnancy.

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