Late Breaking Abstract - Risk Factors for Adverse Respiratory Outcomes in Infants with Congenital Lung Malformations

<bold>Background:</bold> Congenital lung malformations (CLM) are a heterogenous group of anomalies diagnosed with increasing frequency antenatally. Malignant transformation has been reported, causing debate on prophylactic excision in asymptomatic patients. <bold>Objective:</bold> To identify risk factors for adverse outcomes in infants that had surgery for symptomatic CLM <bold>Methods:</bold> Single centre retrospective observational study (January 1995-December 2023) of all children with CLM that underwent resectional surgery <bold>Results:</bold> Forty-nine infants (33 males) underwent surgery for CLM at 5 (1-10) days. Antenatal diagnosis was established in 45 (91.8%) patients and 18 underwent antenatal intervention (thoraco-amniotic shunt n=24, aspiration n=3, laser ablation n=3). Mediastinal shift was detected antenatally in 27 (55%), who were more likely to have had antenatal interventions (p=0.001) but did not exhibit worse outcomes. Survival was 91.8% (45/49). Early delivery (p=0.014), lower birthweight (p=0.015), pre-operative ventilatory requirement (p=0.04) and pre-operative pneumothorax (p=0.005), higher pre-operative oxygen requirement and oxygenation-index were associated with death. Six infants had malignant changes on histology. Those cases were more likely to require pre-operative intubation (p=0.008), have higher oxygen requirements pre-operatively (median 45%, range 30–80, p=0.013) and a longer duration of respiratory support post-operatively (median 11 days, range 5–18, p=0.035). <bold>Conclusions:</bold> We have identified factors associated with adverse outcomes including malignant changes arising from CLMs which may help inform surgical management.