Congenital Lung Malformations in Neonates: A 9-Year Tunisian Cohort Highlighting Diagnostic Challenges and Outcomes...

Congenital lung malformations (CLMs) represent a broad spectrum of developmental anomalies with highly variable prenatal and postnatal presentations and outcomes. Their postnatal management remains non-standardized. This study aimed to describe the spectrum of bronchopulmonary malformations diagnosed in the neonatal period, assess the contribution of antenatal and postnatal imaging, and characterize their clinical course and management in a resource-limited setting.

We conducted a retrospective descriptive study in the Intensive Care Unit of the Maternity and Neonatology Centre of Tunis, over a 9-year period. All newborns diagnosed with CLMs were included. Data were collected from obstetric, neonatal, and pediatric surgery records.

Twenty-three newborns were included (prevalence: 0.23 per 1000 live births; M/F ratio: 0.91). The mean gestational age was 37.5 ± 2.9 weeks, and mean birth weight 2901 ± 833 g. Antenatal diagnosis was achieved in 65% of cases ( $n=15/23$ ) at a mean gestational age of 24.4 ± 4.5 weeks, following documented prenatal ultrasound screening in 74% of cases ( $n=17/23$ ). Respiratory distress occurred in 78% of newborns. The most frequent diagnoses were congenital pulmonary airway malformation (57%), pulmonary sequestration (22%), pulmonary hypoplasia (13%), and tracheal atresia (9%). Conservative management was used in 65% of cases, while surgery was required in four cases. In-hospital mortality was 34.8% and was significantly associated with respiratory distress (p = 0.04), delivery room resuscitation, comorbidities (p = 0.03), and associated malformations (p = 0.03).

While symptomatic CLMs in resource-limited settings carry significant early mortality due to system-level constraints, active conservative surveillance was associated with favorable outcomes in selected asymptomatic patients in this cohort when supported by structured parental education.