Fetal therapy for congenital diaphragmatic hernia: past, present and future
Bibliographic record
Abstract
Congenital diaphragmatic hernia (CDH) affects 1/2500-5000 infants and is associated with significant neonatal morbidity and mortality related to pulmonary hypoplasia and pulmonary hypertension. Current estimates of perinatal mortality are between 30-40%. With advances in neonatal and surgical management and now improvements in prenatal diagnosis and intervention, further reduction in mortality is anticipated. Data from the international Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, have demonstrated the efficacy of fetal endoscopic tracheal occlusion (FETO) in severe left CDH (LCDH). Although promising, this intervention also has potential for significant morbidity related to prematurity and iatrogenic mortality if reversal of tracheal occlusion is unsuccessful. The implementation of FETO must proceed cautiously within Level III fetal therapy centers and with rigorous outcomes monitoring of centers offering this therapy, ensuring that they are experienced in antenatal severity assessment of CDH, FETO insertion and removal and are integrated with expert, standardized neonatal CDH centers with availability of Extracorporeal life support (ECLS). Further research is needed to better understand the impact of prematurity on FETO survivors, the role of FETO in moderate LCDH, Right CDH (RCDH) and non-isolated CDH in carefully selected circumstances as well as the development of alternative, less invasive, fetal therapies that can specifically target both pulmonary hypoplasia and pulmonary hypertension.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".