Over the past decade, Johns Hopkins Medicine has been pivotal in advancing care for severe congenital diaphragmatic hernia (CDH), a condition in which fetal organs move into the chest cavity through a hole in the diaphragm, preventing development of normal lungs.

At Johns Hopkins Medicine, survival for CDH is above 85%, compared to a national average of between 65% and 70%, even as it treats the most severe cases. This success is attributable to the Johns Hopkins Center for Fetal Therapy at The Johns Hopkins Hospital, a pioneer in the fetoscopic endoluminal tracheal occlusion (FETO) procedure, which increases lung development in utero.

Johns Hopkins Medicine is a regional and national referral center for the most severe CDH cases, with the FETO program integrated into a broader continuum of maternal-fetal and neonatal care. The center’s fetal therapy physicians, along with neonatologists and pediatric surgeons, work together to improve lung development and reduce reliance on extracorporeal membrane oxygenation (ECMO).

Babies who are born with CDH have breathing problems that can be life-threatening, explains Ahmet Baschat, director of the Center for Fetal Therapy, who brought the FETO technique to Johns Hopkins Medicine and the mid-Atlantic region about 10 years ago.

“One of the reasons I came to Hopkins was that I wanted to start this therapy here,” he says. “You can’t implement a high-quality program with just one component. You have to have an excellent neonatal intensive care and pediatric surgery team, and you need a dedicated CDH program.”

(L-R: Shaun Kunisaki, Suneetha Desiraju, Ahmet Baschat)

Baschat works closely with neonatologist Suneetha Desiraju and pediatric surgeon Shaun Kunisaki. Together with their teams, they offer a cohesive strategy to all patients with CDH. 

This integrated model has been central to Johns Hopkins Medicine’s success and has helped establish the institution as one of the most experienced centers in the country for this procedure.

The FETO procedure is performed by using a fetoscope to place a balloon in the trachea then inflate it with sterile saline. This balloon achieves blockage of the trachea, which results in expansion of the lungs in the chest cavity.

FETO procedures are now done earlier in fetal development than previously, Baschat says, typically occurring at about 28 weeks with balloon removal at 34 weeks. Careful surveillance of patients for signs of preterm labor has allowed most mothers to carry to term after FETO.

Several innovations have improved FETO and post-FETO care at Johns Hopkins Medicine over the past decade. One, says Baschat, is the pediatric surgery team’s use of living muscle tissue to repair the diaphragm, instead of a biomaterial patch that does not grow with the baby.

Johns Hopkins Medicine neonatologists have also created ventilation techniques for babies who undergo FETO in the first 48 hours after delivery, vastly reducing reliance on ECMO as the baby’s lungs develop, says Baschat.

As FETO evolves, Johns Hopkins Medicine’s leadership reflects a broader principle in fetal intervention: Innovation must be paired with systems of care capable of supporting families through highly complex, high-stakes pregnancies.