High-risk fetal congenital pulmonary airway malformations have a variable response to steroids

Lee M. Morris, Foong Yen Lim, Jeffrey C. Livingston, William J. Polzin, Timothy M. Crombleholme

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Background/Purpose: Anecdotal reports suggest that maternal steroids may arrest the growth of congenital pulmonary airway malformations (CPAMs), preventing or reversing hydrops. We reviewed our experience with CPAMs to determine the fetal response to steroid therapy. Methods: This study is a retrospective review of all fetal CPAMs from 2004 to 2008. Fetuses with high-risk CPAMs that received at least one course of steroids were identified. Fetal magnetic resonance imaging and ultrasound data were used to classify the CPAMs, identify hydrops fetalis and follow the fetuses poststeroid dosing. Results: Forty-four fetuses with CPAM were identified. Fifteen patients were found to have received at least one course of steroids. Thirteen were hydropic and 2 were nonhydropic. Seven of the 13 hydropic fetuses (54%) showed an initial response to steroid administration, whereas the 2 nonhydropic high-risk fetuses progressed to birth without developing hydrops. Seven of the 15 patients, however, resulted in fetal demise or early postnatal death, giving a survival rate of 53%. Conclusions: High-risk CPAMs have a variable response to steroids. This variable response demonstrates the need for a placebo-controlled randomized study to more accurately determine the effect of steroids on hydrops and CPAM growth rates. Repeated steroid courses may not be helpful, and progression in CPAM volume to head circumference ratio (CVR) or hydrops should prompt open fetal surgery to prevent irreversible fetal insult.

Original languageEnglish (US)
Pages (from-to)60-65
Number of pages6
JournalJournal of Pediatric Surgery
Volume44
Issue number1
DOIs
StatePublished - Jan 1 2009

Keywords

  • Congenital cystic adenomatoid malformation
  • Congenital pulmonary airway malformation
  • Fetal surgery
  • Hydrops fetalis
  • Steroids
  • Thoracoamniotic shunt

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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