Long-term outcome after fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review.

OBJECTIVE: This systematic review aimed to evaluate the long-term outcomes of infants who had undergone fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH). METHODS: PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to October 2025 for studies reporting infant outcome ≥ 1 year post FETO in the following domains: growth and nutritional, neurodevelopmental, audiological, cardiac, respiratory, gastrointestinal and musculoskeletal. Quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials and the Newcastle-Ottawa scale for cohort studies. Meta-analysis was not performed due to outcome heterogeneity and a narrative synthesis was conducted instead. RESULTS: Fourteen studies (one randomized controlled trial and 13 cohort studies), including a total of 395 infants, were analyzed. The duration of follow-up ranged from 7 to 87 months. Among domains of morbidity, respiratory complications were the most prevalent, although most improved over time. Growth failure affected a significant proportion of infants at 1 year, but considerable catch-up growth was demonstrated by 2 years. Gastrointestinal morbidity was common, with gastroesophageal reflux disease reported in 25-50% of cases and hernia recurrence in 21-43%. Neurodevelopmental outcome was generally reassuring. Multiple studies found no significant differences in long-term outcome between infants that underwent FETO and those that did not after adjusting for disease severity. CONCLUSION: FETO-treated CDH survivors experience substantial but improving multisystem morbidity that may be driven by factors independent of the intervention itself, emphasizing the need for long-term multidisciplinary follow-up. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.