Delivery planning for congenital lung malformations: A CVR based perinatal care algorithm

Area of Science:

• Perinatal Medicine
• Pediatric Surgery
• Fetal Surgery

Background:

• Congenital lung malformations (CLMs) are a spectrum of developmental abnormalities.
• The Congenital Lung Malformation Volume Ratio (CVR) is a key metric in assessing CLM severity.
• A CVR threshold of ≥1.1 is a strong predictor of the need for urgent perinatal surgical intervention.

Purpose of the Study:

• To develop a delivery planning and clinical management algorithm for CLM based on a CVR threshold of 1.1.
• To differentiate management strategies for CLM based on prenatal CVR assessment.

Main Methods:

• Retrospective cohort study of fetuses with CLM evaluated between May 2015 and November 2020.
• Analysis of demographics, ultrasound findings, and late gestation CVR (≥27 weeks).
• Nonparametric univariate analysis and ROC curve analysis to correlate CVR with clinical outcomes.

Main Results:

• Of 65 CLMs with assessable CVR, 72% had a CVR <1.1.
• All 18 CLMs with CVR ≥1.1 required resection, with 13 needing fetal intervention or urgent neonatal surgery.
• CLMs with CVR ≥1.1 demonstrated 100% sensitivity and NPV for hydrops, fetal intervention, and urgent neonatal surgery.

Conclusions:

• CLM with CVR ≥1.1 necessitates delivery at specialized centers prepared for neonatal resuscitation and potential urgent surgery.
• CLM with CVR <1.1 may allow for delivery at the patient's hospital of choice, simplifying management.
• The CVR threshold provides a valuable tool for guiding perinatal care and delivery planning for CLM.