{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T11:58:31Z","timestamp":1776945511829,"version":"3.51.4"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The TOTAL Trial demonstrated the efficacy and safety of prenatal treatment of isolated severe left Congenital Diaphragmatic Hernia (CDH). Since this trial was completed, the application of the fetal approach in selected non\u2010isolated CDH cases has become a daily clinical and ethical reality, raising the question of extending the indication to fetoscopic endotracheal occlusion (FETO) to selected non\u2010isolated cases where no guidance is available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This study examines the ethical and clinical implications of offering FETO for non\u2010isolated Congenital Diaphragmatic Hernia (CDH). It analyzes current ethical frameworks in fetal surgery and draws comparisons with similar debates concerning patients with genetic conditions and\/or neurological impairment that necessitate major procedures, such as organ transplantation. We revised the literature, including data from extensive CDH registries, to assess survival rates and the variability of associated anomalies. A multidisciplinary, patient\u2010centered decision\u2010making framework was developed to guide clinical considerations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Recent data suggest that survival outcomes in some syndromic CDH cases may be comparable to those of isolated CDH, challenging the rationale for a priori exclusion from fetal therapy. Ethical analysis highlights the need for individualized assessments rather than categorical restrictions, emphasizing the principles of beneficence, non\u2010maleficence, autonomy, and justice. Decision\u2010making should extend beyond survival rates to consider long\u2010term quality of life and parental values.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The absence of definitive evidence should not lead to the denial of potential benefits when a reasonable chance of improved outcomes exists. Instead, a multidisciplinary, patient\u2010 and family\u2010centered approach should guide fetal therapy decisions, ensuring ethical integrity while adapting to the evolving landscape of prenatal medicine.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6856","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T12:07:46Z","timestamp":1751976466000},"page":"1176-1181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010Isolated Congenital Diaphragmatic Hernia. Can We Think of a Beacon of Hope?"],"prefix":"10.1002","volume":"45","author":[{"given":"Isabella","family":"Fabietti","sequence":"first","affiliation":[{"name":"Fetal and Perinatal Medicine and Surgery Unit Area of Fetal Neonatal and Cardiological Sciences Bambino Ges\u00f9 Children's Hospital and Research Institute  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3996-3448","authenticated-orcid":false,"given":"Chiara","family":"Vassallo","sequence":"additional","affiliation":[{"name":"Fetal and Perinatal Medicine and Surgery Unit Area of Fetal Neonatal and Cardiological Sciences Bambino Ges\u00f9 Children's Hospital and Research Institute  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Viggiano","sequence":"additional","affiliation":[{"name":"Fetal and Perinatal Medicine and Surgery Unit Area of Fetal Neonatal and Cardiological Sciences Bambino Ges\u00f9 Children's Hospital and Research Institute  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Caforio","sequence":"additional","affiliation":[{"name":"Fetal and Perinatal Medicine and Surgery Unit Area of Fetal Neonatal and Cardiological Sciences Bambino Ges\u00f9 Children's Hospital and Research Institute  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Bagolan","sequence":"additional","affiliation":[{"name":"Senior Consultant at the Pediatric Academy and Standing Member Clinical Ethics Committee Bambino Ges\u00f9 Children's Hospital, Research Institute  Rome Italy"},{"name":"Department of Systems Medicine University of Tor Vergata  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2027030"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2014.09.004"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.02.040"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4052"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22182"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372\u2010022\u201001357\u2010x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6450"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2021.09.034"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2026983"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm198212233072623"},{"issue":"3","key":"e_1_2_11_12_1","first-page":"221","article-title":"The Fetal Patient\u2010Ethical Aspects of Fetal Therapy","volume":"3","author":"Deprest J.","year":"2011","journal-title":"Facts Views Vis Obgyn."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010024\u201005922\u20108"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010animal\u2010030117\u2010014637"},{"key":"e_1_2_11_15_1","volume-title":"Principles of Biomedical Ethics","author":"Beauchamp T. 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Sentieri nella medical humanities","author":"Malacrida R.","year":"2023","journal-title":"Osservatorio di Etica"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2024.05.016"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6407"},{"issue":"1","key":"e_1_2_11_24_1","article-title":"Prenatal Management of the Fetus With Isolated Congenital Diaphragmatic Hernia in the Era of the TOTAL Trial","volume":"25","author":"Deprest J.","year":"2020","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5139"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000448096"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2023.02.009"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4995"},{"issue":"11","key":"e_1_2_11_29_1","first-page":"1093","article-title":"Improving Outcomes for Congenital Diaphragmatic Hernia","volume":"172","author":"Harrison M. 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