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.