Prenatal Intervention in High-Risk CPAM: Postnatal Outcomes After Fetal versus Standard Surgery: A Propensity Score...

Area of Science:

• Pediatric Surgery
• Fetal Medicine
• Congenital Lung Anomalies

Background:

• Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly with variable severity.
• Severe CPAM can lead to life-threatening complications like hydrops fetalis and mediastinal shift.
• Fetal surgical intervention is an option for severe cases, but its impact on postnatal outcomes is unclear.

Purpose of the Study:

• To evaluate the effect of fetal surgical intervention on subsequent postnatal surgical outcomes in pediatric CPAM patients.
• To compare outcomes between CPAM patients who underwent prenatal surgery versus those treated with postnatal surgery only.

Main Methods:

• Retrospective single-center cohort study of CPAM patients (January 2010 - August 2024).
• Propensity score matching (gestational age, gender, birth weight, lesion volume ratio) created two groups: fetal surgery (n=14) and postnatal surgery only (n=9).
• Assessment of baseline characteristics, fetal intervention types, intraoperative, and long-term postoperative outcomes; multivariable regression analysis.

Main Results:

• The fetal surgery group had significantly higher baseline disease severity (hydrops, mediastinal shift) compared to the control group.
• No significant differences were observed in primary outcomes like mortality (15% vs. 0%) and recurrence (29% vs. 0%).
• Secondary outcomes (ventilation duration, ICU stay) were longer in the fetal surgery group but not statistically significant.

Conclusions:

• Fetal intervention for CPAM, despite higher initial disease severity, did not adversely affect postnatal surgical recovery.
• Postnatal outcomes in the fetal surgery group were comparable to those with less severe CPAM treated postnatally.
• Findings support selective prenatal intervention for high-risk CPAM and highlight the need for refined prenatal and postnatal strategies.