Updates

Leading fetal care

Since 2001, Texas Children’s Hospital’s Fetal Center has been at the forefront of innovations in fetal diagnostics and intervention therapies. The following data represents our most recent evaluations, procedures, and outcomes.

Overall fetal center totals

Evaluations
1,045 – 2023
11,225 – Total

Fetoscopic procedures
147 – 2023
1,565 – Total

EXIT (ex-utero intrapartum treatment) procedures
2 – 2023
64 – Total

Open fetal surgeries excluding EXITs
0 – 2023
54 – Total

Fetal echocardiograms
2,875 – 2023
31,682 – Total

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.

Patients evaluated for amniotic band syndrome

  • 3 - 2023
  • 40 - Total

Fetoscopic interventions for amniotic band release

  • 0 - 2023
  • 7 - Total

Survival rate after fetoscopic procedure

  • 100%

Learn more about Amniotic Band Syndrome

Learn more about amniotic band resection

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through December 2022.

Patients evaluated for CDH

  • 42 – 2022
  • 446 – Total

Number of FETO (fetal endoscopic tracheal occlusion procedures)

  • 6 – 2022
  • 41 – Total

Average number of newborns with CDH cared for each year in NICU

  • 22

Survival to discharge for isolated CDH*

  • 84%

Survival to discharge for CDH with associated anomalies

  • 62%

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.

EXIT-to-airway

  • 2 – 2023
  • 41 – Total

EXIT-to-ECMO (extracorporeal membrane oxygenation)

  • 0 – 2023
  • 2 – Total

EXIT-to-resection of high-risk lung mass

  • 0 – 2023
  • 21 - Total

Learn more about EXIT Procedures

Learn more about lung lesions or CCAM

Number of open and catheter-based fetal cardiac interventions

  • 6 – 2023
  • 43 – Total

Number of fetuses undergoing chronic maternal hyperoxygenation for borderline left heart

  • 0 – 2023
  • 14 – Total

Learn more about Fetal Cardiac Intervention

Learn more about hypoplastic left heart syndrome

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2022.

All Patients evaluated for Congenital Lung Malformation (CLM)

  • 28 – 2022
  • 375 – Total

Patients evaluated for high risk CLM*

  • 6 – 2022
  • 83 – Total

Survival to discharge for low risk CLM**

  • 99%

Survival to discharge for high risk CLM

  • 85%

Open fetal surgeries for CLM

  • 0 – 2022
  • 4 – Total

Survival to discharge for open fetal surgeries for CLM

  • 75%

EXIT to resection for CLM

  • 0 – 2022
  • 21 – Total

Survival to discharge for EXIT to resection procedures

  • 95%

*Defined as those with hydrops or CLM volume ratios ≥ 1.6
**Two deaths due to non-pulmonary-related problems

Learn more about Fetal Lung Malformations

Learn more about open fetal surgeries for CCAM

Learn more about EXIT-to-resection procedures

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2021.

Patients evaluated for fetal tumors, including cervical, mediastinal and sacrococcygeal teratomas

  • 8 – 2021
  • 71 – Total

Patients evaluated for fetal neck masses (lymphatic malformations)

  • 4 – 2021
  • 62 – Total

EXIT-to-airway procedures performed to treat patients with cervical tumors or epignathic tumors, and lymphatic malformations

  • 0 – 2021
  • 29 – Total

Learn more about Fetal Tumors

Learn more about Neck Masses

Learn more about EXIT-to-airway procedures

The following data represents procedures and outcomes from the Fetal Center's inception through December 2022.

Below you will find a detailed report for the outcomes of all FETO cases at our center. This information includes all left, right, and bilateral CDH cases who underwent FETO. We believe that the details regarding these outcomes as reported here are important to provide to families. We defined Isolated FETO cases as ones that had no other major anomalies and or genetic abnormalities.

  FETO Cases (n=41)
Isolated (n=30)* Non-Isolated (n=11)
Method of Balloon Removal    
Ultrasound Guided Puncture 21/29 (72%) 6/11 (55%)
Fetoscopic Removal 4/29 (14%) 1/11 (9%)
EXIT Procedure 4/29 (14%) 4/11 (36%)
Method of Delivery    
Vaginal Delivery 13/29 (45%) 5/11 (45%)
Cesarean Delivery 12/29 (41%) 5/11 (45%)
EXIT Delivery 4/29 (14%) 1/11 (9%)
Gestation Age at Delivery    
Median [range] 35.6 [30.7 - 40.1] 36.1 [32.9 - 38.7]
Mean 35 ± 2.3 35.9 ± 1.6
ECMO 9/29 (31%) 5/8 (63%)**
Age at Surgery (days)    
Median [range] 4 [1 - 25] 2 [1 - 7]
Mean 5 ± 5 3 ± 2
Survival to Discharge*** 22/28 (79%) 4/10 (40%)
Length of stay in NICU (days)    
Median [range] 75 [30 - 294] 140 [56 - 158]
Mean 102 ± 70 123 ± 40
Discharged home on oxygen 10/22 (45%) 4/4 (100%)

Data are expressed as median [minimum maximum range], mean ± standard deviation, or as numerator/denominator (percentage).
* 1 IUFD at 33.7 weeks gestation
** 3 neonatal deaths <24 hours of life
*** 1 patient in each group remains in NICU pending discharge

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.

Patients evaluated for LUTO

  • 25 – 2023
  • 219 – Total

Fetal bladder shunts

  • 0 – 2023
  • 85 – Total

Learn more about Lower Urinary Tract Obstruction (LUTO)

Learn more about fetal bladder shunts

The following data represents evaluations, procedures and outcomes from December 2011 through the end of December 2022.

Patients evaluated for NTD

65 – 2023

654 – Total

Fetal NTD Repair

  • Open fetal procedures
    • 0 – 2023
    • 44 – Total
  • Fetoscopic procedures
    • 28 – 2023
    • 169 – Total

Fetal NTD repair outcomes

Fetal Myelomeningocele
(fMMC) repair cases


 
All fetoscopic
cases
(n=140)
Fetoscopic
3 Layer Closure
(n=102)
All open cases
(n= 44)
MOMs trial*
(n=78)
Delivery outcomes
Number of patients delivered

(n=137)1

(n=99)1

(n=44)

(n=78)

Overall rate of treatment for hydrocephalus for all fetoscopic & open fMMC cases: 49/134 (37%)

Results reflect available outcomes data from 12 / 2011 to 12 / 2022

Gestational Age at Surgery        
Median [range] 25.3 [22.9-26.9] 25.1 [24.0-26.4] 24.8 [21.3-25.9] ---
Mean 25.2 ± 0.6 25.1 ± 0.5 24.6 ± 1.2 23.6 ±1.4
Prenatal/Neonatal Demise 2/139 (1.4%) 2/101 (2%) 1/44 (2%) 2/78 (3%)
Gestational Age at Delivery        
Median [range] 37.4 [25.1-40.9] 37.1 [25.1-40.9] 35.8 [26.4-37.9] ---
Mean 36.4 ± 3.4 36.3 ± 3.5 35.1 ± 2.7 34.1 ± 3.1
Preterm Premature Rupture of Membranes
(<37 weeks gestation)
46/137 (29%) 36/99 (31%) 9/44 (20%) 36/78 (46%)
Preterm Delivery        
less than 37 weeks gestation 59/137 (43%) 45/99 (31%) 27/44 (61%) 62/78 (79%)
less than 30 weeks gestation 8/137 (6%) 6/99 (3%) 4/44 (9%) 10/78 (13%)

Vaginal Delivery
 

71/137 (52%)
 

50/99 (49%)
 

0/44 (0%)
 

0/78 (0%)
 
Birthweight        
Median [range] 2885 [755-4545] 2875 [755-4545] 2613 [624-3635] ---
Mean 2823 ± 768 2834 ± 773 2518 ± 663 2383 ± 688
Treatment for Hydrocephalus at 12 months or less  37/96 (40%)3 22/71 (31%)3 12/38 (32%)2 31/78 (40%)
1. Excludes 2 IUFD and 1 pending delivery in the fetoscopic group
2. Excludes 1 demise and 5 lost to follow up in the open group
3. Only includes patients who have reached 12 months of age

Walking Status at 30 months for fetoscopic repair

Below you will find a detailed report for walking status for our fetoscopic cases. We believe that the details regarding walking status as reported here are important to provide to families. Not every center defines walking independently in the same manner. Here at Texas Children's Fetal Center we take a conservative approach when classifying walking status. We have looked at every child who has had a fetoscopic repair to determine their primary method of daily ambulation at 30 months or above.  Many children are able to take a few steps independently, but when we classify a child as walking independently, that reflects their primary method of ambulation in their daily life. 85% of our fetoscopic patients are able to walk, whether it be independently, with orthotics and/or devices like a walker.

TCH Fetoscopic results - 30 Months and older  MOMs trial results - 30 Months and older 
Walking Status  Count  Percentage  Walking Status  Count  Percentage 
Walking  any form 

60

87% 

Walking  any form 

44

71% 

Walking – independent of braces or walker 

17 

25% 

Walking – independent of braces or walker

26

42%

Walking   with orthotics 

24

25% 

Walking – with orthotics or devices

18

29%

Walking  with devices 

19

28% 

None – wheelchair dependent 

9 

13% 

None – wheelchair dependent

18

29%

Total # of patients with available information 

69

Total # of patients with available information 

62

*Adzick, S., Thom, E., Spong, C., Brock, J., Burrows, P., Johnson, M.,… Farmer, D. (2011). A randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine, 364, 993-1004.

Belfort, M., Whitehead, W., Shamshirsaz, A., Bateni, Z., Olutoye, O. O., Olutoye, O.A., …Cass, D. (2017). Fetoscopic open neural tube defect repair: Development and refinement of a two-port, carbon dioxide insufflation technique. Obstetrics and Gynecology, 4, 734-743.

Learn more about Neural Tube Defects (NTD) - Spina Bifida

Learn more about fetoscopic procedures

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2022.

Patients evaluated for omphalocele

  • 12 – 2022
  • 151 – Total

Survival for isolated omphalocele in live-born infants

  • 93%

Learn more about Omphalocele

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2022.

Open procedures

  • 0 – 2022
  • 54 – Total

Cardiac teratoma

  • 0 – 2022
  • 1 – Total

Lung lesions and teratomas

  • 0 – 2022
  • 8 – Total

Neural tube defects

  • 0 – 2022
  • 45 – Total

Learn more about Open Fetal Surgery for SCT & Vascular Tumors

Learn more about Open Fetal Surgery for Lung Masses/CCAM

Learn more about Open Fetal Surgery for Spina Bifida

The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2022.

Total evaluations for TTTS

  • 83 - 2022
  • 1258 - Total

Fetal surgical interventions to treat TTTS

  • 65 - 2022
  • 819 - Total

Fetal surgical intervention to treat TTTS in triplet pregnancies

  • 0 - 2022
  • 32 - Total

The following data reflects selective fetoscopic laser photocoagulation (SFLP) cases, including those with selective fetal growth restriction, performed from January 2015 – December 2022.

 Overall TTTS survival

  • 90% survival of at least one twin
  • 67% survival of both twins
 
  Total Cases
Two Survivors 219 (67.2%)
One Survivor 73 (22.4%)
No Survivors 34 (10.4%)

Survival per Quintero stage

Stage Two Survivors One Survivor No Survivors
I 39 (75%) 10 (19.2%) 3 (5.8%)
II 91 (73.4%) 18 (14.5%) 15 (12.1%)
III 126 (60%) 55 (26.2%) 29 (13.8%)
IV 13 (48.1%) 8 (29.6%) 6 (22.2%)

Survival by gestational age at procedure

Gestational age 2 survivors 1 survivor 0 survivors
16-18 weeks 80 (59.7%) 32 (23.9%) 22 (16.4%)
19-21 weeks 111 (67.3%) 31 (18.8%) 23 (13.9%)
22-24 weeks 57 (67.1%) 21 (24.7%) 7 (8.2%)
25-27 weeks 15 (68.2%) 7 (31.8%) 0 (0%)

Learn more about Twin-Twin Transfusion Syndrome (TTTS)

*This data excludes Triplets, TAPS, etc. Only includes true TTTS mo/di twins with and without sFGR

40 cases excluded: no 30 day outcomes available to us

GA represented in mean ± standard deviation


 

Fetal Cardiology Program

Learn mroe about volumes and outcomes for those patients treated by the Fetal Cardiology program.

Archives

Learn more about the excellent outcomes and results we’ve achieved. Read our 2018 Volume and Outcomes Summary.