EP06.25: Fetal ultrasound predictors for early postnatal intervention in congenital pulmonary airway malformations

Most cases with congenital pulmonary airway malformations (CPAM) are operable on a standby basis, but some cases require surgery in the neonatal period, and there are no clear parameters to predict the outcome in the fetal period. In the present study, we examined predictive factors on fetal ultrasound in CPAM cases requiring surgery in the early postnatal period. Forty-three cases prenatally diagnosed as CPAM and performed prenatal management at our institute between 2012 and 2023 were included in this study. Fetal ultrasound was retrospectively reviewed to extract changes over time in CVR (CPAM Volume Ratio: CPAM volume (cm3) x 0.52/head circumference), tumour volume/estimated body weight ratio (vol/EFBW), left and right pulmonary artery (PA) diameter, PA Doppler parameters (pulsatility index=PI and acceleration/ ejection time (AT/ET) ratio). Three time points (At diagnose, at max CVR, close to delivery) were evaluated. Group E and Group L were divided by the timing of postnatal surgery (before or after 40 days from birth). Statistical analysis was performed by Mann Whitney test or Wilcoxon matched-pairs signed rank test, and p < 0.05 was considered significant. Group E had 9 cases, and Group L had 34 cases. Compared the groups, vol/EFBW was significantly higher in group E at the time of diagnosis (p < 0.01: 3.9 ± 2.1% vs 1.9 ± 1.8%), and CVR was significantly higher in group E before birth (p = 0.01:1.0 ± 0.5 vs 0.4 ± 0.3). At the time of diagnosis, the ipsilateral PA diameter was significantly bigger than the contralateral PA in group E (p < 0.05: 2.6 ± 0.64 vs 2.2 ± 0.50), whereas there was no difference in group L. There were no significant differences in PA PI or AT/ET in either side compared to the two groups. Bigger ipsilateral PA diameter and high vol/EFBW at diagnosis, and higher CVR before birth are risk parameters for requiring early postnatal surgery.