Babies saved by operation in womb

Doctors have reported apparently significant improvements in survival rates in babies born with holes in their diaphragm, by enlarging their lung capacity in the weeks before they are born.

The babies cannot breathe properly because their developing liver pushes up into their chest cavity and prevents the lungs growing. About one in 3,000 babies is born with this abnormality and half die soon afterwards, although surgery within two or three days helps others survive.

Now doctors at King's College hospital, London, and hospitals in Barcelona and the Belgian city of Leuven have developed a technique that improves the life chances of some of the foetuses most severely at risk.

It involves inserting telescopic equipment through the mother's womb, through the foetus's mouth and into the chest cavity, and inflating a balloon which creates more room for the lungs to grow. It also aids the growth factors in the foetus's lungs.

The operation, which only takes a few minutes in all but the most difficult cases, is carried out when the foetus is 26 to 29 weeks old, and the balloon is removed shortly before birth. The baby can undergo rapid surgery to repair the diaphragm soon after birth.

The doctors, reporting in the journal Ultrasound in Obstetrics and Gynaecology, detail the results from 21 cases. Of the first 10, only three survived 18 months. Of the next 11, seven survived. During the same period 17 families declined such treatment for the foetuses. In five cases, the pregnancies were terminated and only one of the 12 babies who were born survived.

The doctors say it is too early to give definite conclusions about these figures, but factors that may have played a part include slightly earlier use of the technique in the foetus, to allow more time for the lungs to develop; the use of an epidural, or local, rather than a general anaesthetic on the mother; and greater experience with the surgery.