Fetal Surgery for Severe Left Diaphragmatic Hernia

Abstract

To the Editor: The lower mortality reported by Deprest et al. (July 8 issue)¹ among infants with severe congenital diaphragmatic hernia who were assigned to fetoscopic intervention than among those who were assigned to expectant care should not be interpreted as endorsing broad application outside well-designed trials at experienced centers. Despite the standardized protocol, the report does not include information regarding adherence to standardized care² during a trial period of more than 10 years at 10 fetal centers and 26 neonatal centers with variable experience treating infants with congenital diaphragmatic hernia. The low use of extracorporeal life support appears inconsistent . . .