Texas Children’s Fetal Center®
Quality and Outcomes
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%
The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through December 2023.
Patients evaluated for CDH
- 31 – 2023
- 477 – Total
Number of FETO (fetal endoscopic tracheal occlusion procedures)
- 4 – 2023
- 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
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
The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.
All Patients evaluated for Congenital Lung Malformation (CLM)
- 34 – 2023
- 409 – Total
Patients evaluated for high risk CLM*
- 8 – 2023
- 91 – Total
Survival to discharge for low risk CLM**
- 99%
Survival to discharge for high risk CLM
- 85%
Open fetal surgeries for CLM
- 0 – 2023
- 4 – Total
Survival to discharge for open fetal surgeries for CLM
- 75%
EXIT to resection for CLM
- 0 – 2023
- 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
The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.
Patients evaluated for fetal tumors, including cervical, mediastinal and sacrococcygeal teratomas
- 2 – 2023
- 82 – Total
Patients evaluated for fetal neck masses (lymphatic malformations)
- 6 – 2023
- 68 – Total
EXIT-to-airway procedures performed to treat patients with cervical tumors or epignathic tumors, and lymphatic malformations
- 1 – 2023
- 30 – Total
The following data represents procedures and outcomes from the Fetal Center's inception through December 2023.
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
- 8 – 2023
- 93 – Total
The following data represents evaluations, procedures and outcomes from December 2011 through the end of December 2023.
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=168) | Fetoscopic 3 Layer Closure (n=129) | All open cases (n=44) | MOMs trial (n=78) |
|---|---|---|---|---|
| Gestational Age at Surgery | ||||
|
Median [Range] |
25.4 wks [22.9 - 26.9] |
25.4 wks [24 - 26.9] |
24.8 wks [21.3 - 25.9] |
-- |
| Prenatal/Neonatal Demise | 2/168 (1%) | 2/129 (2%) | 1/44 (2%) | 2/78 (3%) |
| Delivery outcomes Number of patients delivered | (n=166)* | (n=127)* | (n=44) | (n=78) |
| Gestational Age at Delivery | ||||
|
Median [Range] |
37.2 wks [25.1 - 40.9] |
37.1 wks [25.1 - 40.9] |
35.8 wks [26.4 - 37.9] |
-- |
| Preterm Premature Rupture of Membranes | 52/166 (31%) | 42/127 (33%) | 9/44 (20%) | 36/78 (46%) |
| Preterm Delivery (<37 weeks gestation) | ||||
| less than 37 weeks gestation | 73/166 (44%) | 59/127 (46%) | 27/44 (61%) | 62/78 (79%) |
| less than 30 weeks gestation | 10/166 (6%) | 8/127 (6%) | 4/44 (9%) | 10/78 (13%) |
| Vaginal Delivery | 84/166 (51%) | 63/127 (50%) | 0/44 (0%) | 0/78 (0%) |
| Birthweight | ||||
|
Median [Range] |
2880 gm [745 - 4545] |
2870 gm [745 - 4545] |
2613 gm [624 - 3635] |
-- |
| Treatment for Hydrocephalus at 12 months or less | 48/134 (36%)** | 33/96 (34%)** | 12/38 (32%)*** | 31/78 (40%) |
| Overall rate of treatment for hydrocephalus for all fetoscopic & open fMMC cases: |
62/174 (36%) |
* Excludes 2 IUFDs
** Only includes patients who have reached 12 months of age
*** Excludes 1 demise and 5 lost to follow up in the open group
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.
The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.
Patients evaluated for omphalocele
- 6 – 2023
- 157 – Total
Survival for isolated omphalocele in live-born infants
- 94%
The following data represents evaluations, procedures and outcomes from the Fetal Center's inception through the end of 2023.
Open procedures
- 0 – 2023
- 54 – Total
Cardiac teratoma
- 0 – 2023
- 1 – Total
Lung lesions and teratomas
- 0 – 2023
- 8 – Total
Neural tube defects
- 0 – 2023
- 45 – Total
Learn more about Open Fetal Surgery for SCT & Vascular Tumors
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 2023.
Overall TTTS survival
- 90.2% survival of at least one twin
- 67.7% survival of both twins
| Total Cases | |
| Two Survivors | 256 (67.7%) |
| One Survivor | 85 (22.5%) |
| No Survivors | 37 (9.8%) |
Survival per Quintero stage
| Stage | Two Survivors | One Survivor | No Survivors |
| I | 44 (77.2%) | 11 (19.3%) | 2 (3.5%) |
| II | 90 (78.9%) | 13 (11.4%) | 11 (9.6%) |
| III | 111 (59.4%) | 55 (29.4%) | 21 (11.2%) |
| IV | 11 (55%) | 6 (30%) | 3 (15%) |
Survival by gestational age at procedure
| Gestational age | Two Survivors | One Survivor | No Survivors |
| 16‐18 weeks | 83 (61.5%) | 34 (25.2%) | 18 (13.3%) |
| 19‐21 weeks | 104 (72.2%) | 25 (17.4%) | 15 (10.4%) |
| 22‐24 weeks | 53 (67.1%) | 22 (27.8%) | 4 (5.1%) |
| 25‐27 weeks | 16 (80%) | 4 (20%) | 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
45 cases excluded: no 30 day outcomes available to us
GA represented in mean ± standard deviation
Fetal Cardiology Program
Learn more about volumes and outcomes for those patients treated by the Fetal Cardiology program.
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