# Postnatal outcomes of sonographically suspected isolated congenital lung anomalies

## TL;DR

This study examines the outcomes of babies diagnosed with isolated congenital lung anomalies before birth and finds that most have good outcomes, though some may need surgery.

## Contribution

The study provides new insights into the postnatal outcomes and diagnostic accuracy of isolated congenital lung anomalies using prenatal ultrasound measurements.

## Key findings

- Most cases of isolated congenital lung anomalies result in live births with favorable outcomes.
- A CPAM volume ratio (CVR) above 1.6 is linked to higher risk and adverse outcomes.
- Postnatal follow-up is crucial as some lesions persist despite prenatal regression.

## Abstract

The aim was to evaluate the prenatal course, postnatal outcome and diagnostic accuracy of fetuses with a prenatal diagnosis of isolated congenital lung anomalies (iCLA).

A retrospective cohort is described from the Amsterdam UMC between January 2007 and January 2022. The CPAM volume ratio (CVR) was calculated. The concordance between prenatal diagnosis and lesion progression was compared to postnatal findings. Postnatal surgical interventions were reported.

This study includes 113 prenatal cases of iCLA. Ten percent (10/100 cases with available CVR) progressed into high-risk lesions (CVR > 1.6), with a negative impact on survival. In total, 108 (95.6%) cases resulted in live birth. Acute respiratory distress was observed in 6.5% (7/108). During postnatal follow-up, the lesion was still detectable in 10/15 (66.7%) cases in which complete regression was seen prenatally. Fifty percent (54/108) of the live-born children required surgical management.

iCLA has a favorable prognosis in pregnancy, however, close prenatal monitoring is advised. Future parents should be informed about the importance of postnatal follow-up since lesions are often persistent even if prenatal scans may no longer have visualized them, as well as the chance of developing respiratory distress and the probability of undergoing surgery.

In cases with a congenital lung anomaly, the CPAM volume ratio (CVR) can be measured prenatally by ultrasound examination as a predictor for a favorable or adverse outcome. A CVR above 1.6 is associated with a high probability of the development of fetal hydrops and adverse outcome. This study demonstrates that the prognosis of an isolated congenital lung anomaly is favorable in most patients. However, it remains challenging to predict acute respiratory distress after birth based on CVR, thus it is suggested that delivery should be within a hospital setting. Subsequently, postpartum imaging should be offered in all patients, as residual lesions often persist, even if prenatal scans may no longer have visualized it.