Management and outcome of antenatally diagnosed congenital cystic adenomatoid malformation of the lung.
OBJECTIVE
To review the management and outcome of babies with antenatally diagnosed congenital cystic adenomatoid malformation.


METHODS
Retrospective cohort review.


METHODS
Tertiary neonatal care unit at Queen Mary Hospital and antenatal diagnostic centre at Tsan Yuk Hospital.


METHODS
Consecutive patients with antenatally suspected congenital cystic adenomatoid malformation in their concepti among antenatal patients attending Tsan Yuk Hospital from 1994 to 2002. Twenty-four of 33 cases were referred to Queen Mary Hospital for postnatal management and for whom comprehensive records were available for analysis in 23.


METHODS
Postnatal interventions in their babies included investigational imaging for congenital cystic adenomatoid malformation and surgery.


METHODS
Antenatal and postnatal outcome, as well as pathology of the excised lesions.


RESULTS
Antenatal outcome: termination of pregnancy in two cases and spontaneous abortion in one; in-utero regression was documented in nine cases and in one hydropic change was apparent. Postnatal outcome: only eight of 20 babies born alive had symptoms in neonatal period. Two developed serious infective complications in infancy, one with documented in-utero regression. Pulmonary parenchymal abnormalities were detected on computed tomography of the thorax in six of seven cases with normal or non-specific chest radiograph findings. Among nine cases with in-utero regression, congenital cystic adenomatoid malformation was confirmed by operative histology in five and abnormal computed tomography findings in three. Fifteen babies underwent surgical excision, one of whom died because of severe pre-existing pulmonary hypoplasia and nine endured minor postoperative complications. A favourable outcome was documented at a mean follow-up of 22 months (range, 2 months-7 years).


CONCLUSIONS
In-utero regression of congenital cystic adenomatoid malformation on antenatal ultrasound may not represent genuine resolution. Computed tomographic thorax should be considered in all newborns with antenatally diagnosed congenital cystic adenomatoid malformation, and if confirmed early operation before first hospital discharge is recommended.
Chow
P C
PC
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong.
Lee
S L
SL
Tang
Mary H Y
MH
Chan
K L
KL
Lee
C P
CP
Lam
Barbara C C
BC
Tsoi
N S
NS
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000022:Abortion, Spontaneous / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology; D020330:Bell Palsy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009123:Muscle Hypotonia / Q000453:epidemiology; D011013:Pneumonectomy; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed