Open-lung biopsy guides therapy in children.
BACKGROUND
Open-lung biopsy is uncommon in children. Modern indications and outcomes are unknown.


METHODS
This is a retrospective review of 64 open-lung biopsies (58 patients) from 1976 to 1996. Open-lung biopsies were used to grade vasculopathy in 8 patients (12% of 64) with pulmonary hypertension and in 10 patients (16% of 64) with combined pulmonary hypertension and lung parenchymal disease. Forty-six biopsies (72%) were obtained to diagnose parenchymal disease. Comparisons were made between biopsies performed from 1976 to 1989 and from 1990 to 1996.


RESULTS
In the period 1990 to 1996, there were significantly more infants (p = 0.03), comorbid disease (p = 0.009), extracorporeal membrane oxygenation support (p < 10(-4)), and ventilator dependence (p = 0.05) and significantly less immunocompromise (p = 0.04). A definitive diagnosis was made in 43 of 64 cases (67%) and altered workup in 63 of 64 cases (98%). No correlation existed between Heath-Edwards grade of microangiopathy and catheterization data. Definitive diagnosis was most strongly associated with a nonimmunocompromised patient (p < 10(-4)). Although only one death (1.5%) was related to open-lung biopsy, the procedure was associated with a 30% inhospital mortality rate and an 11% morbidity rate. Of the 19 deaths, 1 patient died from the procedure, 13 died from their diseases, and 5 had support withdrawn. Death was associated with preoperative ventilator dependence (p < 10(-4)) and extracorporeal membrane oxygenation (p = 0.007).


CONCLUSIONS
Pediatric open-lung biopsy commonly alters the diagnostic workup (98%). It is recommended for children who have been supported for 2 weeks by extracorporeal membrane oxygenation and for those with combined pulmonary hypertension and parenchymal lung disease. It is less useful in immunocompromised children.
Jaklitsch
M T
MT
Department of Surgery, University of Minnesota, Minneapolis 55455, USA. mjaklitsch@partners.org
Linden
B C
BC
Braunlin
E A
EA
Bolman
R M
RM
Foker
J E
JE
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000473:pathology*; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000401:mortality / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D013908:Thoracotomy