Conservative post‐natal management of antenatally diagnosed congenital pulmonary airway malformations

Makhijani, Allya V; Wong, Flora Y.

doi:10.1111/jpc.13727

Cited by 19 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The median age at resection was 6.7 months (interquartile range ¼ 3.6-11.4). 27 Style CC concluded that early elective resection of congenital lung malformations prior to 4 months of age is feasible and not associated with increased operative risk. 28 Most current studies have been conducted to determine the optimal timing for CPAM resection within the first year of life.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not?

Zeng

Liang

et al. 2021

Eur J Pediatr Surg

View full text Add to dashboard Cite

Introduction Infection is undoubtedly the most important factor in influencing the timing and surgical strategy of congenital pulmonary airway malformation (CPAM) surgery. However, there have been no studies on the optimal timing of surgery for patients based on the probability of infection. The aim of this study was performed to explore the optimal timing of surgery of CPAM in children from the risk of infection. Materials and Methods The correlation of age distribution and pulmonary infection of 237 children diagnosed by pathology from January 2012 to January 2020 in Guangzhou Women and Children's Medical Center were analyzed retrospectively. We defined the cases with preoperative computed tomographic findings of infection, pathological findings of large number of neutrophils, tissue cells, and abscess formation as the infection group. Results The rate of infection in patients less than 2 years old was significantly lower than in patients over 2 years old (11.4% vs. 45.7%, p < 0.001). And the pulmonary lobectomy rate of patients with infection (29.0%) was significantly higher than in noninfected patients (17.2%) and whole patients (36.3%), p = 0.033. Patients with infection lose more blood during surgery (noninfected patients: 81.76 ± 13.14 mL, infected patients: 145.10 ± 25.39 mL, p = 0.027). The univariate analysis revealed that the infection rate of patients over 2 years old was 3.084 times that of patients ≤2 years old (odds ratio [OR]: 3.084, 95% confidence interval [CI]: 1.196–7.954; p = 0.020). The infection rate of CPAM types III and IV patients is lower than types I and II (OR: 0.531, 95% CI: 0.307–0.920; p = 0.024). Conclusion In consideration of the high risk of infection, lower minimally invasive surgery rate, an increased rate of pulmonary lobectomy, and more blood loss in patients over 2 years old, our study also supports early surgical treatment. Therefore, we suggest that for asymptomatic patients with CPAM I and CPAM II, surgical treatment should be performed when they are less than 2 years old, providing more options for surgical strategies and monitoring of CPAM patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not?

Zeng

Liang

et al. 2021

Eur J Pediatr Surg

View full text Add to dashboard Cite

show abstract

“…In those with age, more than 6 months and mild to moderate symptoms, conservative management with closed observation is narrated. [13,14] We had lobectomy of all patients, as was indicated.…”

Section: Discussionmentioning

confidence: 99%

Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

Iqbal

Liaqat

Saleem³

et al. 2021

J Pediatr Adolesc Surg

View full text Add to dashboard Cite

Background: Congenital Lobar emphysema (CLE) is one of the rarest cystic lesions in the thoracic cavity among children. It is often misdiagnosed and managed incorrectly. We are reporting our institutional experience and recommendations regarding the prevention of common errors in the management of this condition. Methods: This study was conducted at the Paediatric Surgery Department, The Children’s Hospital & the University of Child Health Sciences Lahore from January 2015 to December 2018. All the patients who underwent thoracotomy for congenital lobar emphysema at our center were included in the study and their charts were reviewed. Results: A total of 19 patients had been treated at our center in this duration. The mean age of patients was 2.85 ± 2.11 months. Thirteen of them (68%) were male and the most common presenting complaint (94.7%) was respiratory distress. Chest X-ray was done in all of the patients while a CT scan was needed in 11 patients (57.9%). The most involved lobe was left upper (n=15). Lobectomy was done in all patients. Post-operative ventilation was required in 2 patients (10.5%) and pneumonia developed in 2 patients (10.5%). The most significant complication was wound infection (9/19, p=<0.01). Conclusion: Our results about perioperative management are consistent, however, we received cases with misdiagnosis. We have proposed recommendations to address this issue.

show abstract

“…Treatment may be conservative or surgical. If an initial “wait and see” approach is adopted (13, 87), lung imaging may be repeated at 18 months of age, and if the CTM is confirmed, surgery should be planned around the 2nd birthday to allow the baby to grow (13). The rationale for this is to allow for possible spontaneous regression of the CTM, and thus a conservative approach is proposed until symptoms occur or when the cyst size changes on lung imaging (15, 16, 88, 89).…”

Section: Evidence On the Diagnostic Approach And Therapeutic Strategimentioning

confidence: 99%

Congenital Lung Malformations: Unresolved Issues and Unanswered Questions

et al. 2019

View full text Add to dashboard Cite

Advances in prenatal and postnatal diagnosis, perioperative management, and postoperative care have dramatically increased the number of scientific reports on congenital thoracic malformations (CTM). Nearly all CTM are detected prior to birth, generally by antenatal ultrasound. After delivery, most infants do well and remain asymptomatic for a long time. However, complications may occur beyond infancy, including in adolescence and adulthood. Prenatal diagnosis is sometimes missed and detection may occur later, either by chance or because of unexplained recurrent or persistent respiratory symptoms or signs, with difficult implications for family counseling and substantial delay in surgical planning. Although landmark studies have been published, postnatal management of asymptomatic children is still controversial and needs a resolution. Our aim is to provide a focused overview on a number of unresolved issues arising from the lack of an evidence-based consensus on the management of patients with CTM. We summarized findings from current literature, with a particular emphasis on the vigorous controversies on the type and timing of diagnostic procedures, treatments and the still obscure relationship between CTM and malignancies, a matter of great concern for both families and physicians. We also present an algorithm for the assessment and follow-up of CTM detected either in the antenatal or postnatal period. A standardized approach across Europe, based on a multidisciplinary team, is urgently needed for achieving an evidence-based management protocol for CTM.

show abstract

Conservative post‐natal management of antenatally diagnosed congenital pulmonary airway malformations

Cited by 19 publications

References 16 publications

Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not?

Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not?

Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

Congenital Lung Malformations: Unresolved Issues and Unanswered Questions

Contact Info

Product

Resources

About