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The long-term outcomes of symptomatic congenital lobar emphysema patients
Dvir Gatt1, Eveline Lapidus-Krol2, Priscilla P L Chiu2
1Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Nonoperative management for symptomatic congenital lobar emphysema (CLE) in infants shows favorable long-term outcomes, potentially avoiding surgery. This approach offers a viable alternative to traditional surgical intervention for CLE.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Neonatology
Background:
- Congenital lobar emphysema (CLE) is a rare congenital lung malformation.
- Surgical (OP) management is the standard for symptomatic CLE, while nonoperative (NOP) is for asymptomatic cases.
- The efficacy of NOP for symptomatic CLE requires further investigation.
Purpose of the Study:
- To evaluate the outcomes of a nonoperative (NOP) approach in infants with symptomatic congenital lobar emphysema (CLE).
- To compare NOP management with surgical (OP) management for symptomatic CLE.
Main Methods:
- Retrospective study of 23 infants with symptomatic CLE treated between 2000-2021.
- Comparison of outcomes between 12 infants managed nonoperatively (NOP) and 11 managed operatively (OP).
- Analysis of clinical characteristics, need for respiratory support, length of stay, and long-term follow-up data.
Main Results:
- No significant differences in diagnosis age, lobe involvement, birth term, postnatal diagnosis, gender, or need for noninvasive support between NOP and OP groups.
- A trend towards higher preoperative oxygen support in the OP group (89% vs. 42%).
- Similar long-term outcomes regarding readmissions, growth, asthma medication, and BMI; importantly, none of the NOP infants required surgery during follow-up.
Conclusions:
- A nonoperative (NOP) approach can yield favorable long-term outcomes for symptomatic congenital lobar emphysema (CLE) infants.
- NOP management represents a potentially effective alternative to surgery for select symptomatic CLE cases.
- Further research is needed to identify predictive markers for guiding clinical decisions in symptomatic CLE management.
Introduction:
Surgical (OP) management for symptomatic congenital lobar emphysema (CLE) is the standard of care with nonoperative (NOP) approach applied for asymptomatic cases. The aim of this study is to report the outcomes for NOP approach to the care of symptomatic CLE infants.
Methods:
A retrospective study of CLE patients treated 2000-2021 at a single institution. Patients with CLE and respiratory symptoms were included.
Results:
Overall, 23 children had symptomatic CLE, and 12 had NOP management. The median age at diagnosis was 38.5 days (50) in the NOP group versus 25 days (20) in the OP group (p = 0.31). There was no significant difference in the location of the involved lobe, term birth, postnatal diagnosis and gender, and both groups required noninvasive support in 33% of the cases. There was a trend towards higher frequency of oxygen support in the OP group preoperatively (89% vs. 42%, p = 0.07). The median length of stay was 14 days in the NOP group compared to a median postsurgery stay of 7.5 days in the OP group. In follow-up, there was no significant difference in respiratory readmission in first year of life, growth delay, treatment with asthma medication or body mass index in the NOP versus OP group. None of the children in the NOP group required surgery during follow-up.
Conclusions:
A NOP approach for symptomatic CLE infants can have favorable long-term outcomes. Further studies will be required to identify markers to aid in clinical decision-making.
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