Isabelle Ruchonnet-Metrailler1, Elise Leroy-Terquem1, Julien Stirnemann2, Pierrick Cros3, Héloïse Ducoin4, Alice Hadchouel5, Naziha Khen-Dunlop6, André Labbé7, Géraldine Labouret8, Marie-Noëlle Lebras9, Guillaume Lezmi5, Fouad Madhi10, Laurent J Salomon11, Guillaume Thouvenin12, Caroline Thumerelle13, Christophe Delacourt14. 1. Pneumologie Pédiatrique, Necker, AP-HP, France; Centre de Référence des Maladies Respiratoires Rares, Paris, France; 2. Gynécologie-Obstétrique, Necker, AP-HP, France; 3. Pneumologie Pédiatrique, CHU Brest, France; 4. Pneumologie Pédiatrique, CH Lens, France; 5. Pneumologie Pédiatrique, Necker, AP-HP, France; Centre de Référence des Maladies Respiratoires Rares, Paris, France; Université Paris-Descartes, Paris, France; 6. Université Paris-Descartes, Paris, France; Chirurgie Pédiatrique, Necker, AP-HP, France; 7. Pneumologie Pédiatrique, CHU Clermont-Ferrand, France; 8. Pneumologie Pédiatrique, CHU Toulouse, France; 9. Pneumologie Pédiatrique, Robert Debré, AP-HP, France; 10. Centre de Référence des Maladies Respiratoires Rares, Paris, France; Pneumologie Pédiatrique, CHI Créteil, France; 11. Gynécologie-Obstétrique, Necker, AP-HP, France; Université Paris-Descartes, Paris, France; 12. Centre de Référence des Maladies Respiratoires Rares, Paris, France; Pneumologie Pédiatrique, Trousseau, AP-HP, France; and. 13. Pneumologie Pédiatrique, CHRU Lille, France. 14. Pneumologie Pédiatrique, Necker, AP-HP, France; Centre de Référence des Maladies Respiratoires Rares, Paris, France; Université Paris-Descartes, Paris, France; christophe.delacourt@nck.aphp.fr.
Abstract
BACKGROUND AND OBJECTIVE: Congenital pulmonary malformations (CPM) are mostly recognized on prenatal ultrasound scans. In a minority of cases, they may impair breathing at birth. The factors predictive of neonatal respiratory distress are not well defined, but an understanding of these factors is essential for decisions concerning the need for the delivery to take place in a tertiary care center. The aim of this study was to identify potential predictors of respiratory distress in neonates with CPM. METHODS: We selected cases of prenatal diagnosis of hyperechoic and/or cystic lung lesions from RespiRare, the French prospective multicenter registry for liveborn children with rare respiratory diseases (2008-2013). Prenatal parameters were correlated with neonatal respiratory outcome. RESULTS: Data were analyzed for 89 children, 22 (25%) of whom had abnormal breathing at birth. Severe respiratory distress, requiring oxygen supplementation or ventilatory support, was observed in 12 neonates (13%). Respiratory distress at birth was significantly associated with the following prenatal parameters: mediastinal shift (P = .0003), polyhydramnios (P = .05), ascites (P = .0005), maximum prenatal malformation area (P = .001), and maximum congenital pulmonary malformation volume ratio (CVR) (P = .001). Severe respiratory distress, requiring oxygen at birth, was best predicted by polyhydramnios, ascites, or a CVR >0.84. CONCLUSIONS: CVR >0.84, polyhydramnios, and ascites increased the risk of respiratory complications at birth in fetuses with CPM, and especially of severe respiratory distress, requiring oxygen supplementation or more intensive intervention. In such situations, the delivery should take place in a tertiary care center.
BACKGROUND AND OBJECTIVE:Congenital pulmonary malformations (CPM) are mostly recognized on prenatal ultrasound scans. In a minority of cases, they may impair breathing at birth. The factors predictive of neonatal respiratory distress are not well defined, but an understanding of these factors is essential for decisions concerning the need for the delivery to take place in a tertiary care center. The aim of this study was to identify potential predictors of respiratory distress in neonates with CPM. METHODS: We selected cases of prenatal diagnosis of hyperechoic and/or cystic lung lesions from RespiRare, the French prospective multicenter registry for liveborn children with rare respiratory diseases (2008-2013). Prenatal parameters were correlated with neonatal respiratory outcome. RESULTS: Data were analyzed for 89 children, 22 (25%) of whom had abnormal breathing at birth. Severe respiratory distress, requiring oxygen supplementation or ventilatory support, was observed in 12 neonates (13%). Respiratory distress at birth was significantly associated with the following prenatal parameters: mediastinal shift (P = .0003), polyhydramnios (P = .05), ascites (P = .0005), maximum prenatal malformation area (P = .001), and maximum congenital pulmonary malformation volume ratio (CVR) (P = .001). Severe respiratory distress, requiring oxygen at birth, was best predicted by polyhydramnios, ascites, or a CVR >0.84. CONCLUSIONS: CVR >0.84, polyhydramnios, and ascites increased the risk of respiratory complications at birth in fetuses with CPM, and especially of severe respiratory distress, requiring oxygen supplementation or more intensive intervention. In such situations, the delivery should take place in a tertiary care center.
Authors: Juneyoug Koh; Euiseok Jung; Se Jin Jang; Dong Kwan Kim; Byong Sop Lee; Ki-Soo Kim; Ellen Ai-Rhan Kim Journal: Korean J Pediatr Date: 2018-01-22