Saranya Gopikrishna1, Amanda Henry1,2,3, Simren Kaur4, Antonia W Shand1,2,5, Ashish Jiwane6, Kate Dyer2, Alec W Welsh1,2. 1. School of Women's & Children's Health, Faculty of Medicine University of New South Wales Randwick New South Wales Australia. 2. Department of Maternal-Fetal Medicine Royal Hospital for Women Randwick New South Wales Australia. 3. Department of Obstetrics & Gynaecology St George Hospital Kogarah New South Wales Australia. 4. Faculty of Medicine University of New South Wales Randwick New South Wales Australia. 5. Children's Hospital at Westmead Clinical School The University of Sydney Sydney New South Wales Australia. 6. Department of Paediatric Surgery Sydney Children's Hospital Sydney New South Wales Australia.
Abstract
INTRODUCTION: To assess fetal vs. neonatal diagnoses, pregnancy outcomes and need for surgery in babies prenatally diagnosed with congenital pulmonary airway malformation (CPAM) or bronchopulmonary sequestration (BPS). METHODS: Retrospective single-centre cohort study of fetuses with a prenatal diagnosis of CPAM or BPS between 2006 and 2014. Data collected included serial antenatal ultrasound information and neonatal/infant diagnoses and outcomes. RESULTS: Initial ultrasound diagnosis (n = 63) was CPAM in 51 and BPS in 12: nineteen (30%) fetuses had mediastinal shift and 2 (3%) had hydrops. All neonates with known birth outcome (n = 56) were liveborn. Final diagnosis in 52 infants (83%) with neonatal imaging and/or histopathology confirmed CPAM in 17/44 (39%) and BPS in 6/9 (67%). Of 34 prenatally suspected but unconfirmed CPAM lesions: 10 had no lesion on neonatal imaging, one no neonatal imaging performed, five confirmed BPS, 11 other lung/thoracic lesions, seven were lost to follow-up. There was one infant death. 27/63 infants (43%) had post-natal surgery. More neonates requiring neonatal respiratory support/resuscitation had surgery compared to those who did not (67% vs. 29%, P = 0.008). Patients with suspected CPAM or BPS on both initial and final ultrasound were more likely to have post-natal surgical management than when a lesion was no longer visible on final antenatal ultrasound (68% vs. 23%, P = 0.001). CONCLUSIONS: Over 50% of antenatally suspected CPAM/BPS either regressed or had an alternate post-natal diagnosis. Perinatal outcome was good, with the majority of neonates/infants conservatively managed. Persistently visible antenatal lesion and need for neonatal respiratory support predicted ultimate surgical management.
INTRODUCTION: To assess fetal vs. neonatal diagnoses, pregnancy outcomes and need for surgery in babies prenatally diagnosed with congenital pulmonary airway malformation (CPAM) or bronchopulmonary sequestration (BPS). METHODS: Retrospective single-centre cohort study of fetuses with a prenatal diagnosis of CPAM or BPS between 2006 and 2014. Data collected included serial antenatal ultrasound information and neonatal/infant diagnoses and outcomes. RESULTS: Initial ultrasound diagnosis (n = 63) was CPAM in 51 and BPS in 12: nineteen (30%) fetuses had mediastinal shift and 2 (3%) had hydrops. All neonates with known birth outcome (n = 56) were liveborn. Final diagnosis in 52 infants (83%) with neonatal imaging and/or histopathology confirmed CPAM in 17/44 (39%) and BPS in 6/9 (67%). Of 34 prenatally suspected but unconfirmed CPAM lesions: 10 had no lesion on neonatal imaging, one no neonatal imaging performed, five confirmed BPS, 11 other lung/thoracic lesions, seven were lost to follow-up. There was one infant death. 27/63 infants (43%) had post-natal surgery. More neonates requiring neonatal respiratory support/resuscitation had surgery compared to those who did not (67% vs. 29%, P = 0.008). Patients with suspected CPAM or BPS on both initial and final ultrasound were more likely to have post-natal surgical management than when a lesion was no longer visible on final antenatal ultrasound (68% vs. 23%, P = 0.001). CONCLUSIONS: Over 50% of antenatally suspected CPAM/BPS either regressed or had an alternate post-natal diagnosis. Perinatal outcome was good, with the majority of neonates/infants conservatively managed. Persistently visible antenatal lesion and need for neonatal respiratory support predicted ultimate surgical management.
Authors: Paul J Yong; Peter Von Dadelszen; Daniela Carpara; Ken Lim; Nancy Kent; Francine Tessier; Marie-France Delisle; Titus Wong; Geoffrey Blair; Erik D Skarsgard Journal: Fetal Diagn Ther Date: 2012-02-03 Impact factor: 2.587
Authors: Linden J Stocker; Diana G Wellesley; Michael P Stanton; Rajeswari Parasuraman; David T Howe Journal: Prenat Diagn Date: 2014-11-04 Impact factor: 3.050
Authors: J K Calvert; P A Boyd; P C Chamberlain; S Syed; S Said; K Lakhoo Journal: Arch Dis Child Fetal Neonatal Ed Date: 2005-08-30 Impact factor: 5.747