The natural history of prenatally diagnosed congenital pulmonary airway malformations and bronchopulmonary sequestrations
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Read the article on jpedsurg.org ↗Article · Mar 2022 · 1 min read
In brief
In brief
Retrospective study of 66 prenatally diagnosed CPAM/BPS cases over 18 years found that 56% regressed during gestation and 69% were managed conservatively with median 4-year follow-up. Mediastinal shift, high CVR, and large lesion size predicted surgical need, supporting watchful waiting for asymptomatic neonates.
Written by the GCMD Library team from the article.
Background
: The natural history of congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) is not fully understood, and the management of the newborn with an asymptomatic lesion is a controversial issue. We aimed to study the natural history and outcome of CPAM/BPS at our institution with a policy of watchful waiting, and to investigate if any prognostic factors in the pre- and/or postnatal- period may predict the need for surgery.
Material and Methods
: A retrospective review study was conducted of children prenatally diagnosed with CPAM and/or BPS during the 18-year period, from 2002 to 2020. Data from the pre- and postnatal period was collected and analysed.
Results
: Sixty- six patients with prenatally observed lung lesions were entered in the study, with an overall survival rate of 94%. Fifty-six percent of the lesions decreased in size during gestation. Thirty-one percent had surgery and 69% could be managed conservatively with a median follow-up of 4 years. Nineteen percent developed symptoms after the neonatal period. Children with a presence of mediastinal shift on postnatal imaging (p=0.003), with a high CVR (p= 0.005) and a large lesion size during gestation (p=0.014) were significantly more likely to require surgery.
Conclusion
: Prenatal regression is common among prenatally diagnosed CPAM/BPS and the majority of children that are asymptomatic beyond the neonatal period will remain asymptomatic throughout their childhood. Future analysis with a longer follow-up might give new insights in order to identify children at risk of developing symptoms.