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Sileo FG, Alameddine S, Iaccarino DA, Di Mascio D, Giuliani GA, Bertucci E, Khalil A, D'Antonio F. Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis. J Perinat Med 2024; 52:457-466. [PMID: 38651628 DOI: 10.1515/jpm-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To report the outcome of fetuses with a prenatal diagnosis of congenital lung malformation (CLM) diagnosed on ultrasound by performing a comprehensive assessment of these outcomes through a systematic review and meta-analysis. CONTENT CLMs are a heterogeneous group of anomalies that involve the lung parenchyma and its bronchovascular structures. Their presentation and evolution are variable, from entirely asymptomatic lesions with sonographic regression in utero to hydropic fetuses requiring fetal therapy, intrauterine death or neonatal morbidity. A systematic review was conducted in Medline, Embase and Cochrane databases including studies on fetuses with CLM diagnosed prenatally in order to report the in-utero natural history of these lesions. Thirty-nine studies (2,638 fetuses) were included in the final review. SUMMARY Regression/reduction in size of the lung lesion during pregnancy was reported in 31 % of cases, while its increase in 8.5 % of cases. Intra-uterine death complicated 1.5 % of pregnancies with fetal CLM, while neonatal and perinatal death were 2.2 and 3 %, respectively. Neonatal morbidity occurred in 20.6 % of newborns with CLM; 46 % had surgery, mainly elective. In fetuses with CLM and hydrops, fetal/perinatal loss occurred in 42 %. Assessment of the role of fetal therapy in improving the outcomes of pregnancies complicated by CLM was hampered by the small number of included cases and heterogeneity of type of interventions. OUTLOOK Fetuses with CLM prenatally diagnosed have a generally favorable outcome. Conversely, there is a low quality of evidence on the actual role of fetal therapy in improving the outcome of fetuses presenting with these anomalies.
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Affiliation(s)
- Filomena Giulia Sileo
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | | | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, 9311 Sapienza University of Rome , Rome, Italy
| | - Giulia Andrea Giuliani
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - Francesco D'Antonio
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
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Pederiva F, Rothenberg SS, Hall N, Ijsselstijn H, Wong KKY, von der Thüsen J, Ciet P, Achiron R, Pio d'Adamo A, Schnater JM. Congenital lung malformations. Nat Rev Dis Primers 2023; 9:60. [PMID: 37919294 DOI: 10.1038/s41572-023-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Congenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.
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Affiliation(s)
- Federica Pederiva
- Paediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy.
| | - Steven S Rothenberg
- Department of Paediatric Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hanneke Ijsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Departments of Radiology and Nuclear Medicine and Respiratory Medicine and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adamo Pio d'Adamo
- Laboratory of Medical Genetics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Penikis AB, Zhou AL, Sferra SR, Engwall-Gill AJ, Miller JL, Baschat AA, Blakemore KJ, Kunisaki SM. Serial lung mass volume ratios as prognostic indicators of neonatal respiratory morbidity in fetal pulmonary malformations. Am J Obstet Gynecol MFM 2023; 5:101128. [PMID: 37572880 DOI: 10.1016/j.ajogmf.2023.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Several studies have shown that the congenital pulmonary airway malformation volume ratio is a useful prognosticator of neonatal outcome in prenatally diagnosed lung lesions. However, there remains a lack of consensus on which congenital pulmonary airway malformation volume ratio values have the best predictive value because of operator dependence, inherent changes in lung lesion size throughout gestation, and the widespread use of maternal steroids. OBJECTIVE This study sought to determine the association between serial congenital pulmonary airway malformation volume ratio measurements and neonatal outcomes among fetuses with lung malformations. STUDY DESIGN This was a retrospective cohort study of fetuses with a prenatally diagnosed lung malformation managed at 2 major fetal centers from January 2010 to December 2021. Prenatal variables, including prospectively measured congenital pulmonary airway malformation volume ratio measurements (initial, maximum, and final), were analyzed. The results were correlated with 3 outcome measures, namely surgical resection before 30 days of life, a need for supplemental O2 at birth, and endotracheal intubation at birth. Statistical analyses were performed using receiver operating characteristic curve analyses, Welch 2 sample t tests, and multivariable logistic regressions (P<.05). RESULTS There were 123 fetuses with isolated lung lesions identified. Eight (6.5%) had hydrops. The mean initial congenital pulmonary airway malformation volume ratio was 0.67±0.61 cm2 at 22.9±3.9 weeks' gestation. The mean maximum congenital pulmonary airway malformation volume ratio was 1.08 ± 0.94 cm2 at 27.0 ± 4.0 weeks' gestation. The mean final congenital pulmonary airway malformation volume ratio was 0.58±0.60 cm2 at 33.2±4.1 weeks' gestation. At a mean gestational age at delivery of 38.3±2.6 weeks, 15 (12.2%) underwent neonatal lung resection for symptomatic disease. In a multivariable regression, all 3 congenital pulmonary airway malformation volume ratio measurements showed a significant correlation with neonatal lung resection (P<.001). Optimal congenital pulmonary airway malformation volume ratio cutoffs were established based on an initial congenital pulmonary airway malformation volume ratio of ≥0.8 cm2, maximum congenital pulmonary airway malformation volume ratio of ≥1.5 cm2, and a final congenital pulmonary airway malformation volume ratio of ≥1.3 cm2 with associated areas under the curve of 0.89, 0.97, and 0.93, respectively. The final congenital pulmonary airway malformation volume ratio had the highest specificity for predicting surgical lung resection in the early postnatal period. CONCLUSION Measuring congenital pulmonary airway malformation volume ratios throughout pregnancy in fetuses with pulmonary malformations has clinical value for prenatal counseling and planning care transition after delivery. Fetuses with a final congenital pulmonary airway malformation volume ratio of more than 1.3 cm2 are likely to require neonatal surgery and therefore should be delivered at tertiary care centers with a neonatal intensive care unit and pediatric surgical expertise.
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Affiliation(s)
- Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Alice L Zhou
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Abigail J Engwall-Gill
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Dr Engwall-Gill)
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Karin J Blakemore
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki).
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Rovani S, Rahshenas M, Salomon LJ, Benachi A, Choupeaux L, Goua V, Jouannic JM, Bouar GL, Massardier J, Rosenblatt J, Sartor A, Thong-Vanh C, Vaast P, Lelong N, Khoshnood B, Delacourt C. Impact of prenatal estimation of the risk of respiratory distress in neonates with congenital pulmonary malformations on the choice of delivery site. Arch Pediatr 2023; 30:195-200. [PMID: 37061356 DOI: 10.1016/j.arcped.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/07/2022] [Accepted: 03/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The vast majority of prenatally diagnosed congenital pulmonary malformations (CPM) remain asymptomatic at birth. The maximal value of the CPM volume ratio (CVRmax) predicts the risk of neonatal respiratory distress (NRD), and should allow for better assessment of the level of expertise needed at the delivery site. AIM This study evaluated the level of maternity units currently chosen for the delivery of CPMs, and determined the impact of the choice of delivery site based on the CVRmax, with a threshold of 0.4 cm2. METHODS Data were extracted from the French prospective MALFPULM cohort, with inclusion between March 2015 and June 2018. RESULTS The final study population consisted of 383 women. Deliveries in level 1 or 2 maternity units (n = 98, 25%) involved CPMs with lower CVRmax (p<0.001), causing fewer signs of prenatal compression (p = 0.025). Among the 62 children (16%) who presented with NRD, only seven (11%) were born in level 1 or 2 units (p = 0.0078). Choosing the maternity level according to the CVRmax would have increased the number of births in level 1 or 2 maternity hospitals by 70%. In these maternity units, the percentage of children with NRD would have increased from 8% in the actual distribution to 10% in the new strategy. CONCLUSION Our results showed an overuse of level 3 maternity hospitals for the delivery of newborns with a prenatal diagnosis of CPM. The use of CVRmax should enable a reduction in the use of expertise centers without an adverse impact on newborns.
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Affiliation(s)
- S Rovani
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
| | - M Rahshenas
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - L J Salomon
- Université de Paris Cité, Paris, France; AP-HP, Hôpital Necker-Enfants Malades, Service d'Obstétrique, Paris, France
| | - A Benachi
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, Université Paris Sud, Clamart, France
| | - L Choupeaux
- AP-HP, Unité de recherche clinique Cochin-Necker, Paris, France
| | - V Goua
- Service d'Obstétrique, CHU Poitiers, France
| | - J-M Jouannic
- AP-HP, Hôpital Armand-Trousseau, Service de Gynécologie-Obstétrique, Université Paris Sorbonne, France
| | - G Le Bouar
- Service d'Obstétrique, CHU Rennes, France
| | - J Massardier
- Hospices Civils de Lyon, HFME, Service d'Obstétrique, France
| | - J Rosenblatt
- AP-HP, Hôpital Robert Debré, Service d'Obstétrique, Paris, France
| | - A Sartor
- Service d'Obstétrique, CHU Toulouse, France
| | | | - P Vaast
- Service d'Obstétrique, CRHU Lille, France
| | - N Lelong
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - B Khoshnood
- Inserm UMR 1153, Maternité Port-Royal, Paris, France
| | - C Delacourt
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France; Université de Paris Cité, Paris, France.
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Garinet S, Rahshenas M, Galmiche-Rolland L, Abbo O, Bonnard A, Hameury F, Khen-Dunlop N, Khoshnood B, Blons H, Delacourt C. Cancer-associated Mutations in Congenital Pulmonary Malformations: A Prospective Cohort. Am J Respir Crit Care Med 2023; 207:615-619. [PMID: 36288557 PMCID: PMC10870910 DOI: 10.1164/rccm.202208-1573le] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Simon Garinet
- Assistance Publique–Hôpitaux
de Paris (AP-HP), Hôpital Européen Georges PompidouParis,
France
| | - Makan Rahshenas
- INSERM 1153, Obstetrical, Perinatal and
Pediatric Epidemiology Research Team (EPOPé)Paris, France
| | | | | | | | | | | | - Babak Khoshnood
- Centre of Research in Epidemiology and
StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research
Team (EPOPé), INSERM, INRAParis, France
| | - Hélène Blons
- Assistance Publique–Hôpitaux
de Paris (AP-HP), Hôpital Européen Georges PompidouParis,
France
- Université Paris
CitéParis, France
| | - Christophe Delacourt
- AP-HP, Hôpital Necker-Enfants
MaladesParis, France
- Université Paris
CitéParis, France
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6
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Ocal A, Demirci O, Dizdaroğulları GE, Kahramanoğlu Ö, Ayhan I, Akalın M, Eriç Özdemir M, Odacılar AŞ, Taşdemir Ü, Celayir A. Can we predict the need for postnatal surgery in patients with prenatal fetal lung masses detected by CVR value? J Gynecol Obstet Hum Reprod 2023; 52:102526. [PMID: 36565926 DOI: 10.1016/j.jogoh.2022.102526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
AIM The purpose of this study is to evaluate whether CPAM-volume ratio (CVR) can predict postnatal management (follow up for resolution and surgical treatment) in fetuses with fetal lung masses in the prenatal period. MATERIALS AND METHODS 44 patients who presented at our center with prenatally diagnosed CPAM (Congenital Pulmonary Airway Malformation) and BPS (Bronchopulmonary Sequestration) were analyzed. Obstetric history and outcomes, karyotype results, CVR, additional sonographic findings, characteristics of masses were recorded. CVR was calculated for all cases. İn the study we sought to identify a CVR threshold and did not use the thresholds classically used in the literature. RESULTS 20 fetal BPS and 24 CPAM cases were analyzed. After excluding 5 patients, 46% of the patients were diagnosed with BPS and 54% with CPAM. İn this study the cut off < 0,53 for CVR is taken, it predicts the no need for postnatal surgery with a sensitivity of 85% and a specificity of 88%. When we take the > 0,76 cut-off value for patients who will require emergency surgery within the first 10 days, it predicts the need for surgery with 90% sensitivity and 89% specificity. In addition, it was determined that all patients with mediastinal shift were operated. CONCLUSION We believe that the CVR value and the presence of mediastinal shift should be evaluated in all cases of CPAM and BPS for prediction of the surgery. Proper counseling about the prognosis could be given to the family in cases with mediastinal shift and CVR value above 0,76.
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Affiliation(s)
- Aydın Ocal
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey.
| | - Oya Demirci
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Gizem Elif Dizdaroğulları
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Işıl Ayhan
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Münip Akalın
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey; Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ali Şahap Odacılar
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ümit Taşdemir
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ayşenur Celayir
- Department of Pediatric Surger, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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