Prenatal characteristics and prognosis of congenital pulmonary airway malformation: a retrospective multicenter cohort study

This study evaluated the impact of prenatal characteristics of congenital pulmonary airway malformation (CPAM) on postnatal outcomes, and investigated management strategies and outcomes in surgical versus non-surgical cases. This retrospective multicenter cohort study included 145 cases of CPAM diagnosed by prenatal ultrasound between January 2019 and May 2024. The cohort was stratified into two groups based on prenatal cystic volume ratio (CVR): CVR < 1.6 (n = 131) and CVR ≥ 1.6 (n = 14) for comparative analysis. Live-born infants were further categorized into surgical (n = 40) and non-surgical (n = 89) groups according to treatment methods. Statistical analyses included chi-square tests, t-tests, logistic regression, and Cox proportional hazards models. Univariate analysis revealed that the prevalence of prenatal large cystic lesions (macrocystic ≥ 0.5 cm), prenatal mediastinal shift, and prenatal pleural effusion/ascites were significantly higher in the CVR ≥ 1.6 group compared to the CVR < 1.6 group (all P < 0.05). The proportion of cases with prenatal CVR ≥ 1.6 combined with prenatal mediastinal shift was significantly greater in the surgical group than in the non-surgical group (P < 0.05). However, multivariate regression analysis demonstrated that after incorporating postnatal variables, prenatal variables (including CVR) were not independent factors influencing surgical intervention. Only postnatal respiratory symptoms were independently associated with the decision for surgical intervention (P < 0.05). Additionally, 95% of surgical procedures were performed within 20 months of birth. Postnatal respiratory symptoms are the primary clinical determinant guiding surgical intervention in infants with CPAM. Prenatal ultrasound parameters may indirectly aid in assessing the risk of surgical intervention through their potential association with postnatal symptoms. Conservative observation is safe and feasible for asymptomatic infants, whereas the onset of respiratory symptoms warrants active consideration of surgical intervention.