Early FETO for Severe Congenital Diaphragmatic Hernia

NCT ID: NCT01731509

Last Updated: 2013-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-06-30

Study Completion Date

2016-12-31

Brief Summary

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Congenital diaphragmatic hernia (CDH) is associated high mortality and morbidity, mainly in those cases with severe forms where there are extremely reduced lung volumes, liver herniation and decreased abnormal pulmonary vascularization. Fetal endoscopic tracheal occlusion performed between 26 and 30 weeks (standard FETO) has been shown to increase fetal pulmonary size and vascularity, and to improve infant survival in isolated severe CDH. Fetal pulmonary response followed FETO can be used to predict outcome and is dependent on the size of the fetal lung prior to the procedure.

We hypothesize that performing an earlier FETO, between 22-24 weeks, fetuses with severe form of CDH will have a better fetal pulmonary response and higher chance of surviving.

Detailed Description

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We pretend to investigate if "early FETO" will improve the survival rate and the fetal pulmonary response, by conducting a randomized controlled trial comparing the results with those fetuses that undergo to "standard FETO" (between 26-28 weeks).

Conditions

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Congenital Diaphragmatic Hernia

Keywords

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congenital diaphragmatic hernia fetoscopy fetal endoscopic tracheal occlusion pulmonary hypoplasia fetal surgery fetal lung

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard FETO

Group of fetus that undergo fetal endoscopic tracheal occlusion between 26 0/7 weeks and 28 6/7 weeks.

Group Type ACTIVE_COMPARATOR

Fetal endoscopic tracheal occlusion

Intervention Type OTHER

FETO will be performed by placing a detachable balloon inside fetal trachea

Early FETO

Group of fetus that undergo fetal endoscopic tracheal occlusion between 22 0/7 weeks and 24 6/7 weeks.

Group Type EXPERIMENTAL

Fetal endoscopic tracheal occlusion

Intervention Type OTHER

FETO will be performed by placing a detachable balloon inside fetal trachea

Interventions

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Fetal endoscopic tracheal occlusion

FETO will be performed by placing a detachable balloon inside fetal trachea

Intervention Type OTHER

Other Intervention Names

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FETO or fetal endoscopic traqueal occlusion

Eligibility Criteria

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Inclusion Criteria

* Fetuses with isolated congenital diaphragmatic hernia (normal fetal karyotype and absence of any associated structural anomaly);
* Gestational age established by last menstruation and/or first trimester ultrasonography;
* Prenatal diagnosis of congenital diaphragmatic hernia before 24 weeks of gestation
* Severe congenital diaphragmatic hernia (at 24 weeks, lung-to-head ratio \<1.0 and at least 1/3 of the liver herniated into the fetal thorax)
* written informed consent (by the patient)

Exclusion Criteria

* Preterm premature rupture of the membranes before randomization
* Preterm labor before randomization
Minimum Eligible Age

22 Weeks

Maximum Eligible Age

28 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Sao Paulo

OTHER

Sponsor Role collaborator

University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Rodrigo Ruano, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Faculdade de Medicina da Universidade de Sao Paulo

Locations

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Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

Central Contacts

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Rodrigo Ruano, MD PhD

Role: CONTACT

Phone: (5511)95739188

Email: [email protected]

Eugenia MA Salustiano, RN

Role: CONTACT

Phone: (5511)2661-6209

Email: [email protected]

References

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Ruano R, Duarte SA, Pimenta EJ, Takashi E, da Silva MM, Tannuri U, Zugaib M. Comparison between fetal endoscopic tracheal occlusion using a 1.0-mm fetoscope and prenatal expectant management in severe congenital diaphragmatic hernia. Fetal Diagn Ther. 2011;29(1):64-70. doi: 10.1159/000311944. Epub 2010 Apr 10.

Reference Type BACKGROUND
PMID: 20389048 (View on PubMed)

Ruano R, Yoshisaki CT, da Silva MM, Ceccon ME, Grasi MS, Tannuri U, Zugaib M. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2012 Jan;39(1):20-7. doi: 10.1002/uog.10142. Epub 2011 Dec 14.

Reference Type BACKGROUND
PMID: 22170862 (View on PubMed)

Ruano R, da Silva MM, Campos JA, Papanna R, Moise K Jr, Tannuri U, Zugaib M. Fetal pulmonary response after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia. Obstet Gynecol. 2012 Jan;119(1):93-101. doi: 10.1097/AOG.0b013e31823d3aea.

Reference Type BACKGROUND
PMID: 22183216 (View on PubMed)

Harrison MR, Keller RL, Hawgood SB, Kitterman JA, Sandberg PL, Farmer DL, Lee H, Filly RA, Farrell JA, Albanese CT. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med. 2003 Nov 13;349(20):1916-24. doi: 10.1056/NEJMoa035005.

Reference Type BACKGROUND
PMID: 14614166 (View on PubMed)

Jani JC, Nicolaides KH, Gratacos E, Valencia CM, Done E, Martinez JM, Gucciardo L, Cruz R, Deprest JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009 Sep;34(3):304-10. doi: 10.1002/uog.6450.

Reference Type BACKGROUND
PMID: 19658113 (View on PubMed)

Deprest J, Gratacos E, Nicolaides KH; FETO Task Group. Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol. 2004 Aug;24(2):121-6. doi: 10.1002/uog.1711.

Reference Type BACKGROUND
PMID: 15287047 (View on PubMed)

Other Identifiers

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8353/12

Identifier Type: -

Identifier Source: org_study_id