Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations | 344 patients | Retrospective cohort | Multi-institutional | 2009 - 2016 | Prenatal diagnosis: Median age 22 weeks | Results: | 5.5% were managed with maternal steroids for hydrops (n=15) | 21.8% had respiratory symptoms at birth (n=75) | 10% required neonatal lung resection (n=34) | Congenital pulmonary airway malformation volume ratio (CVR) was significantly associated with perinatal outcome (p< 0.0001) | Initial CVR ≤ 1.4 → reduced risk for hydrops | CVR < 0.9 → low risk for respiratory symptoms | Conclusion: According to this study, CVR ≤ 1.4 indicates low hydrops risk in fetuses, and CVR < 0.9 shows asymptomatic disease at birth, suggesting improved prenatal care standardization. | https://doi.org/10.1097/SLA.0000000000004566 | Source: Kunisaki, SM et. al. | Fetal Program, Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD | @StayCurrentMD | @gigenace | Cincinnati Children's changing the outcome together | ANNALS of SURGERY OPEN
Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations
Infographic · Aug 2023 · 2 min read
In brief
In brief
Multi-institutional study of 344 prenatally diagnosed congenital lung malformations identifies CVR thresholds for risk stratification: initial CVR ≤1.4 predicts low hydrops risk, while maximum CVR <0.9 correlates with asymptomatic disease at birth. Findings support standardized prenatal counseling and delivery planning based on quantitative fetal imaging metrics.
- Initial CVR ≤1.4 identifies fetuses at very low risk for hydrops in prenatally diagnosed congenital lung malformations.
- Maximum CVR <0.9 predicts asymptomatic disease at birth, enabling better delivery planning and parental counseling.
- 21.8% of neonates had respiratory symptoms at birth; 10% required neonatal lung resection in this 344-patient cohort.
- CVR measurements significantly correlate with perinatal outcomes including respiratory distress, oxygen need, and ventilator use.
- Prenatal intervention remains uncommon (1.7%); maternal steroids used in 5.5% of cases with hydrops.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with anatomical illustrations of a fetus and lungs. Key statistics are displayed in large colored percentages on the left side, while a yellow conclusion box appears on the right. Calendar and fetal icons provide visual context for the study parameters.
"Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations: Results from a Multi-Institutional Research Collaborative"
Authors: Kunisaki, Shaun M. MD, MSc; Saito, Jacqueline M. MD, MSCI†; Fallat, Mary E. MD; Peter, Shawn D. St. MD; Lal, Dave R. MD, MPH; Karmakar, Monita PhD; Deans, Katherine J. MD, MHSc; Gadepalli, Samir K. MD, MBA; Hirschl, Ronald B. MD; Minneci, Peter C. MD, MHSc; Helmrath, Michael A. MD; for the Midwest Pediatric Surgery Consortium
Full article: https://gcmd.co/3QMruKo
Objective:
The aim of this study was to assess current clinical outcomes in children with prenatally diagnosed congenital lung malformations (CLMs) and to identify prenatal characteristics associated with adverse outcomes.
Summary Background Data:
Despite a wide spectrum of clinical disease, the identification of fetal CLM subgroups at increased risk for hydrops and respiratory compromise at delivery has not been well defined.
Methods:
A retrospective cohort study was conducted using an operative database of prenatally diagnosed CLMs managed at 11 children’s hospitals from 2009 to 2016. Statistical analyses were performed using nonparametric bivariate or multivariable logistic regression.
Results:
Three hundred forty-four children were analyzed. Fifteen (5.5%) fetuses were managed with maternal steroids in the setting of hydrops, and prenatal surgical intervention was uncommon (1.7%). Seventy-five (21.8%) had respiratory symptoms at birth, and 34 (10.0%) required neonatal lung resection. Congenital pulmonary airway malformation volume ratio (CVR) measurements were recorded in 169 (49.1%) cases and were significantly associated with perinatal outcome, including hydrops, respiratory distress at birth, need for supplemental oxygen, neonatal ventilator use, and neonatal resection (P < 0.001). An initial CVR ≤1.4 was significantly correlated with a reduced risk for hydrops [area under the curve (AUC), 0.93; 95% confidence interval (CI), 0.87–1.00]. A maximum CVR <0.9 (AUC, 0.72; 95% CI, 0.67–0.85) was associated with a low risk for respiratory symptoms at birth.
Conclusions:
In this large, multi-institutional study, an initial CVR ≤ 1.4 identifies fetuses at very low risk for hydrops, and a maximum CVR < 0.9 is associated with asymptomatic disease at birth. These findings represent an opportunity for standardization and quality improvement for prenatal counseling and delivery planning.