Prenatal Imaging Predicts Need for Early Intervention in Neonates With Congenital Lung Malformations

Congenital lung malformations (CLMs) encompass a range of structural anomalies that can affect neonatal outcomes. Advances in prenatal imaging have improved detection of CLMs but clinical implications can widely differ from children being asymptomatic at birth to requiring advanced respiratory support or urgent surgical intervention. We aimed to compare ultrasound (US) and magnetic resonance imaging (MRI)-based prenatal markers for infants with prenatally diagnosed CLMs in order to better predict early postnatal outcomes.

This study is a single-center retrospective review of outcomes in term neonates with prenatally diagnosed CLMs who underwent fetal MRI from 2002 to 2023. Patients requiring early surgery within 30 d of birth or advanced respiratory support were compared against controls that did not require early intervention. Prenatal US and MRI markers were used to predict need for early intervention using univariable and multivariable analyses, P < 0.05 was considered significant.

We evaluated 106 term neonates, with 18 in the early intervention group (nine underwent early surgery and nine required non-invasive positive pressure ventilation or intubated mechanical ventilation). Significant predictors for early intervention included second trimester US lesion size, lesion growth on follow-up US, and second trimester MRI lesion volume. Receiver operating characteristic (ROC) curve analysis demonstrated that US and MRI measures were similarly moderately predictive (areas under the curve: 0.77 and 0.72), and a multivariable stepwise logistic regression showed that US lesion size was most predictive of early intervention (odds ratio 1.022, P = 0.019) CONCLUSIONS: Prenatal MRI and US characteristics-particularly those related to increased size, growth, and mass effect-are associated with an increased risk of requiring early intervention in neonates with CLMs.