Character and Frequency of Early Postnatal Resection in Prenatally Diagnosed Congenital Lung Malformations

Abstract

Introduction: Currently, risk stratification criteria and indications for early postnatal resection of high-risk congenital lung malformations (CLM) are not universally accepted. In this study, we sought to characterize prenatal risk factors and outcomes associated with early postnatal resection in prenatally diagnosed CLMs.

Methods: Retrospective cohort study of patients seen at the Fetal Care Center from January 2014 to December 2023. Categorical data were analyzed with chi-square calculations. Receiver operating characteristic curves were generated for optimal CPAM volume ratio (CVR) and imaging cutoff values associated with hydrops development and/or need for early resection.

Results: Of the 204 patients analyzed, 10.2% (21/204) patients underwent early postnatal resection. Hydropic fetuses required early resection significantly more than non-hydropic fetuses (33.3% vs. 5.0%, p < 0.001). A greater number of early resection patients had macrocystic lesions compared to non-early resection patients (76.2% vs. 12.3% p < 0.001). A maximum CVR ≥1.66 was highly predictive of early postnatal resection (AUC = 0.90; 95% CI = 0.84-0.96). An initial CVR <0.88 indicated a low likelihood of developing hydrops (negative predictive value = 98.6%).

Conclusion: Prenatally, hydrops, macrocysts, and a maximum recorded CVR ≥1.66 are associated with early postnatal resection. Hydrops development is unlikely with an initial CVR <0.88.

Keywords: Congenital lung lesion; Congenital pulmonary airway malformation; Early postnatal resection; Ex utero intrapartum treatment; Fetal intervention; Hydrops fetalis.