Management of congenital lung malformations in Scottish paediatric centres

Abstract

Introduction: Fetal anomaly scanning increases the diagnosis of congenital lung malformations(CLMs). Uncertainty exists regarding best management; conservative versus elective removal. CLM cases following introduction of routine fetal anomaly scanning in the two largest Scottish centres were reviewed. Both provide antenatal counselling with ongoing long term joint medical/surgical follow up. The Scottish CLM group have regular national multidisciplinary discussion of cases (neonatology, surgery, respiratory, radiology,pathology) via teleconference. Methods: Prospective data collected for babies diagnosed antenatally and postnatally with CLM from 2008-2019. We report CT diagnosis, management;conservative vs. surgery for each group. Results: 114 babies had CLM (M:F; 62:52). 89 antenatal/25 postnatal diagnoses. CT diagnosis in antenatal group: 43/89(48%)cystic, 12/89(13%)sequestration, 12/89(13%)bronchial atresia spectrum(BAS), 9/89(10%) hybrid, 7/89(8%) lobar overinflation, 1/89(1%) foregut duplication cyst, 5/89(6%) normal. CT diagnosis in postnatal group: 16/25(64%) lobar overinflation, 5/25(20%)cystic, 3/25(12%)sequestration, 1/25(4%)BAS. Overall, 57/114(50%) had surgery and 57/114(50%) continue conservative management. In the antenatal group 40/89(45%) had surgery and 49/89(55%)conservative. In the postnatal group 17/25 (68%) had surgery and 8/25(32%) conservative. Conclusions: In our centres half of babies born with CLM had surgery. Cystic malformations are the commonest radiological diagnosis in those with an antenatal diagnosis and lobar overinflation is most common in the postnatal group. Collaboration between centres and unified databases would help clarify the optimum management of this patient group.