Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions

Tsai, Anthony; Liechty, Kenneth W.; Hedrick, Holly L.; Bebbington, Michael; Wilson, R. Douglas; Johnson, Mark P.; Howell, Lori J.; Flake, Alan W.; Adzick, N. Scott

doi:10.1016/j.jpedsurg.2007.10.032

Cited by 97 publications

(61 citation statements)

References 37 publications

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“…Also, none of the cases had antenatal maternal steroid administration. In contrast, local practice for postnatal management of asymptomatic infants with CCAM varies from expectant management with serial imaging to elective surgery at about 1 year of age with the aim of preventing malignancy or infection, which reflects the controversy in the literature [1,5,6]. …”

Section: Methodsmentioning

confidence: 99%

Prediction of Pediatric Outcome after Prenatal Diagnosis and Expectant Antenatal Management of Congenital Cystic Adenomatoid Malformation

Yong

Dadelszen²,

Carpara³

et al. 2012

Fetal Diagn Ther

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Objective: To determine whether the congenital cystic adenomatoid malformation (CCAM) volume ratio (CVR) is associated with fetal and postnatal outcome after prenatal diagnosis and antenatal expectant management in a provincial tertiary referral center that does not offer fetal surgery. Methods: Retrospective cohort of 71 consecutive cases of prenatally diagnosed CCAM meeting study criteria (1996–2004). CVR was calculated on the initial ultrasound at the referral center, and associated with hydrops (Fisher’s exact test) and a composite adverse postnatal outcome consisting of death, intubation for respiratory distress, extracorporeal membrane oxygenation, non-elective surgery for symptomatology, or respiratory infection requiring hospital admission (Mann-Whitney test). Results: A CVR >1.6 was significantly associated with hydrops (p = 0.003). In addition, the CVR was significantly associated with the composite adverse postnatal outcome (p = 0.004) at a mean age of follow-up of 41 months (range <1–117 months). For CVR and postnatal outcome, the area-under-the-curve receiver operating characteristic was 0.81 (95% CI 0.69–0.93, p = 0.006), and choosing a CVR cut-off of <0.56, the negative predictive value was 100% (95% CI 0.85–1.00). Conclusion: In a provincial referral center with antenatal expectant management of CCAM, the CVR was associated with hydrops and postnatal outcome, with a CVR <0.56 predictive of good prognosis after birth.

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Section: Methodsmentioning

confidence: 99%

Prediction of Pediatric Outcome after Prenatal Diagnosis and Expectant Antenatal Management of Congenital Cystic Adenomatoid Malformation

Yong

Dadelszen²,

Carpara³

et al. 2012

Fetal Diagn Ther

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“…Today, routine prenatal US screening complemented with magnetic resonance imaging (MRI) has become increasingly valuable in detecting CPAMs [40], with an accuracy of 65-91% [41,42]. Before the advent of prenatal sonography, CPAMs were diagnosed only in symptomatic infants or as an incidental finding.…”

Section: Diagnosismentioning

confidence: 99%

Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation

2016

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Congenital pulmonary airway malformation (CPAM) is one of the most common lung lesions detected prenatally. Despite the research efforts made in the past few years, controversy and lack of clarity in the literature still exist regarding nomenclature, classification, pathogenesis and the management of CPAM. Therefore, it is of greatest importance to delineate the natural history of CPAMs and to create a consensus to guide the management and follow-up of these lesions. This review will focus on classification systems, highlighting the most recent advancements in pathogenesis, and current practice in the prenatal diagnosis of CPAM. Strategies of prenatal management and postnatal management will be reviewed. Long-term follow-up, including lung cancer risk, is discussed and an outcome perspective is presented.

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“…Families should be counseled that the outcome of the pregnancy is likely to depend largely upon GA at delivery, and the presence of the chest lesion is unlikely to change the duration of gestation in the absence of hydrops. Surgical prognosis for the affected fetus can be expected to be excellent for asymptomatic infants in the absence of prematurity-related complications, as we have previously reported [24,25]. Thus, decisions regarding the pregnancy should be made independent of its status as a multiple gestation, but rather on the basis of lesion severity and expected natural history.…”

Section: Discussionmentioning

confidence: 90%

Outcomes of Prenatally Diagnosed Lung Lesions in Multigestational Pregnancies

Vrecenak

Howell²,

Khalek³

et al. 2014

Fetal Diagn Ther

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Background: The outcomes of prenatally diagnosed lung lesions in the context of multigestational pregnancies are unknown. Methods: Of 960 fetal lung lesion cases evaluated at a single tertiary center over 16 years, 30 occurred in multigestational pregnancies. We reviewed this series to aid in prenatal counseling of affected families and to provide prognostic information for decision making. Pre- and postnatal clinical characteristics were gathered for these pregnancies, and the morbidity and mortality were determined for both affected and normal fetuses, whether twins or triplets. Results: Mortality was found to be 3/30 (10%) for affected fetuses, and morbidity in normal co-twins was consistent with the degree of prematurity. No morbidity was seen in co-twins born at or after 36 weeks of gestation. Median gestational age at delivery was 35 5/7 weeks. Conclusions: Outcomes for the affected fetus correlate with the size and pathophysiologic consequences of the lesion and are not worse than previously reported outcomes for similar lesions in singleton pregnancies, while morbidity in the normal co-twin is consistent with prematurity related to the fetal age of the multiple gestation at delivery, irrespective of the fetal lung lesion.

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Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions

Cited by 97 publications

References 37 publications

Prediction of Pediatric Outcome after Prenatal Diagnosis and Expectant Antenatal Management of Congenital Cystic Adenomatoid Malformation

Prediction of Pediatric Outcome after Prenatal Diagnosis and Expectant Antenatal Management of Congenital Cystic Adenomatoid Malformation

Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation

Outcomes of Prenatally Diagnosed Lung Lesions in Multigestational Pregnancies

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