Clinical outcome of antenatally detected congenital lung malformations: a non-operative approach.

Abstract

The postnatal management of asymptomatic antenatally detected congenital lung malformations (CLM) has been controversial. The aim of this project is to report the clinical outcome of a non-operative approach to management of CLMs detected antenatally. The medical records of all children with CLM detected antenatally, born between 1999 and 2014 and referred to the Royal Children’s Hospital, Melbourne were reviewed. 113 patients were identified with a median follow up period of 7.9 years. Chest x-rays performed in the first year were available for review. No abnormality was detected in 31 overall and only 2 of those who ultimately had resection. In the neonatal period, 2 infants died prior to surgery (hydrops/prematurity) and 6 had resection of which 1, who had alveolar capillary dysplasia, died. Beyond infancy, 17 became symptomatic of whom 13 had resection (mass effect 3, infection in CLM 10) and 5 were managed conservatively. 88 remained asymptomatic of whom 11 had elective resection (parent request 2, recurrent cough, not related to CLM 2, mass effect 3, not specified 4) and 77/113 (68%) managed conservatively. There has been 1 death in this group unrelated to CLM. No malignancies were identified. In conclusion, a non-operative approach provides a safe and effective strategy for the management of antenatally detected CLMs with excellent medium to long term clinical outcome.