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Prenatal growth characteristics and pre/postnatal management of bronchopulmonary sequestrations.

Authors
  • Riley, John S1
  • Urwin, John W1
  • Oliver, Edward R1
  • Coleman, Beverly G1
  • Khalek, Nahla1
  • Moldenhauer, Julie S1
  • Spinner, Susan S1
  • Hedrick, Holly L1
  • Adzick, N Scott1
  • Peranteau, William H2
  • 1 The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • 2 The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: [email protected]
Type
Published Article
Journal
Journal of Pediatric Surgery
Publisher
Elsevier
Publication Date
Feb 01, 2018
Volume
53
Issue
2
Pages
265–269
Identifiers
DOI: 10.1016/j.jpedsurg.2017.11.020
PMID: 29229484
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The prenatal natural history of intralobar and extralobar bronchopulmonary sequestrations (BPSs), including lesion growth patterns and need for prenatal intervention, have not been fully characterized. We review our series of BPSs to determine their natural history and outcomes in the context of the need for prenatal intervention. A retrospective review of the pre/postnatal course of 103 fetuses with an intralobar (n=44) or extralobar BPS (n=59) managed at a single institution between 2008 and 2015 was performed. Outcomes included prenatal lesion growth trajectory, presence of hydrops, need for prenatal intervention, survival, and postnatal surgical management. Most extralobar (71%) and intralobar BPSs (94%) decreased in size or became isoechoic from initial to final evaluation. Peak lesion size occurred at 26-28weeks gestation. Eight fetuses developed hydrothorax, four of which (all extralobar BPSs) also developed hydrops. All four hydropic fetuses received maternal betamethasone, and three hydropic fetuses underwent thoracentesis and/or thoracoamniotic shunt placement with subsequent hydrops resolution. All fetuses survived. Forty-one intralobar (93%) and 35 extralobar BPSs (59%) were resected after birth. BPSs tend to decrease in size after 26-28weeks gestation and rarely require fetal intervention. Lesions resulting in hydrothorax ± hydrops can be effectively managed with maternal steroids and/or drainage of the hydrothorax. IV. Copyright © 2017 Elsevier Inc. All rights reserved.

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