Outcome of infants operated on for congenital pulmonary malformations

Pediatr Pulmonol. 2016 Dec;51(12):1367-1372. doi: 10.1002/ppul.23472. Epub 2016 May 27.

Abstract

Introduction: Patients operated on for congenital pulmonary malformations (CPM) have excellent survival rates, but little is known about long-term morbidity. Our aim is to report the sequelae in patients operated on for CPM in infancy and to define factors that may influence their outcome.

Methods: All patients operated on for major congenital anomalies are followed in a dedicated outpatient program and evaluated at 6, 24, and 48 months of life (corrected for gestational age) and at school age at 4, 6, 8, and 12 years of life. The data are prospectively collected. Patients operated on for CPM and enrolled in the follow-up clinic between January 2004 and December 2010 are compared with a control group of term infants operated on for inguinal hernia, without other major congenital or acquired abnormalities. The two groups were compared for auxological, respiratory, and orthopedic outcome.

Results: In the study period, 76 consecutive patients with CPM attended our dedicated follow-up clinic. Eight non-operated patients were excluded from the study. Age at follow-up was 82.0 (56.1-103.7) months in CPM patients and 83.5 (75.2-90.4) months in controls (P = 0.79). Fifty-three patients with CPM (78%) had one or more clinical or radiological abnormality versus six (16%) control patients (OR [95%CI] 16.5 [5.8-47.2]; P < 0.0001).

Conclusions: Over 50% of patients with CPM present long-term sequelae, regardless type of malformation. Therefore, long-term follow-up of patients operated on for CPM is recommended. Further studies are needed to define if, in asymptomatic patients, surgery may modify the natural history of CPM. Pediatr Pulmonol. 2016;51:1367-1372. © 2016 Wiley Periodicals, Inc.

Keywords: congenital pulmonary malformations; follow up; outcomes; surgery.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Bronchodilator Agents / therapeutic use
  • Bronchopulmonary Sequestration / physiopathology
  • Bronchopulmonary Sequestration / surgery
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cystic Adenomatoid Malformation of Lung, Congenital / physiopathology
  • Cystic Adenomatoid Malformation of Lung, Congenital / surgery
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Lung / abnormalities
  • Lung / surgery*
  • Male
  • Odds Ratio
  • Pneumonectomy / methods*
  • Pulmonary Emphysema / congenital
  • Pulmonary Emphysema / physiopathology
  • Pulmonary Emphysema / surgery
  • Respiratory Sounds
  • Respiratory System Abnormalities / physiopathology
  • Respiratory System Abnormalities / surgery*
  • Respiratory Tract Infections / epidemiology
  • Thoracic Surgical Procedures / methods
  • Thoracic Wall / abnormalities
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Bronchodilator Agents

Supplementary concepts

  • Congenital lobar emphysema