Prediction of postnatal outcome in fetuses with congenital lung malformation: 2‐year follow‐up study

Abstract

Objectives To identify prenatal predictors for the need for postnatal respiratory support and surgery in fetuses with a congenital lung malformation (CLM) by calculating the CLM volume ratio (CVR); (2) To evaluate concordance between prenatal appearance and postnatal type of CLM. Methods All included fetuses (2007‐2016) had a CVR measurement on ultrasound at 20‐24 (US1), 24‐30 (US2), and/or 30‐36 (US3) weeks’ gestation. Postnatal diagnosis of CLM was based on computed tomography or histology. Primary outcomes were need for respiratory support within 24 hours and surgery within 2 years after birth. Results Of 80 fetuses, fourteen (18%) had required respiratory support on the first postnatal day, and 17 (21%) had required surgery within 2 years. Only the CVR at US2 was predictive for respiratory support. Four of 16 (25%) fetuses who showed full regression prenatally required respiratory support. The CVR at both US2 and US3 was predictive for surgery within 2 years. Overall, the prenatal appearance of the CLM showed low concordance with the postnatal type. Prenatally suspected microcystic congenital pulmonary airway malformation (CPAM) appeared after birth to be congenital lobar overinflation in 15/35 (43%) of cases. Respiratory support within 24 hours after birth and surgical resection within 28 days after birth were needed in all cases of macrocytic CPAM. Conclusions The CVR predicts need for respiratory support and need for surgery. Prenatal regression of the CLM does not rule out respiratory problems after birth.