Fetal therapy: an eye towards the future
The field of fetal therapy has, by necessity, always involved innovation. The tools that were first used to help babies in the womb had to be borrowed from other more established fields. This borrowing continues to this day but fetal therapy has matured with its own dedicated instruments, protocols and care paths. Collaboration between maternal, fetal and pediatric providers has established a framework upon which even more rigorous innovation can occur. For example, a randomized controlled trial about open fetal surgery to repair spina bifida built upon years of animal research and early successful forays into human fetal surgery showed that fetal surgery was not only superior to postnatal surgery but that fetal therapy could be innovative in a rigorous way (1).
This series describes the current state of fetal therapy but also highlights the dramatic innovations that are taking place across the field. Novel therapy for diseases that were once universally fatal or debilitating is developing at a rapid clip in the area of gene therapy. Investigators are trialing minimally invasive techniques across the world to repair fetal spina bifida with less maternal morbidity. A randomized trial about fetoscopic tracheal occlusion for congenital diaphragmatic hernia has finished recruiting and publication its highly anticipated results is imminent. Novel therapy for anuric renal disease is being studied systematically and prospectively. Artificial environments for premature fetuses’ continued development with fetal physiology are maturing and nearing clinical trials.
Fetal therapy, which began in a few labs most prominently in San Francisco, is now a mature multi-dimensional field. Therapy is offered all over the world and innovation with rigorous study, trials and continued collaboration are clearly the path forward.
Acknowledgments
We dedicate this series to the memory of Dr. Eric Jelin who was a dear colleague, friend, and rising start in fetal therapy who contributed immensely to the field.
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Translational Pediatrics for the series “Fetal Surgery”. The article did not undergo external peer review.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tp-21-164). The series “Fetal Surgery” was commissioned by the editorial office without any funding or sponsorship. Eric Jelin served as the unpaid Guest Editor of the series. George Mychaliska served as the unpaid Guest Editor. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Adzick NS, Thom EA, Spong CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011;364:993-1004. [Crossref] [PubMed]
