title: Favorable outcomes in high-risk congenital pulmonary airway malformations treated with multiple courses of maternal betamethasone.
abstract: OBJECTIVE
  Congenital pulmonary airway malformations (CPAMs) are rare congenital lung lesions often diagnosed by prenatal ultrasound. High-risk cases can result in hydrops and prenatal or postnatal demise. Antenatal betamethasone has resulted in improved survival but it is unclear how to manage patients who do not respond to a single course.
  
  
  METHODS
  We present a bi-institutional retrospective review of patients treated with multiple courses of prenatal steroids for high-risk CPAMs between 2007 and 2013.
  
  
  RESULTS
  Nine patients met inclusion criteria. All but one either had an increased CPAM volume ratio (CVR) or number of fluid-containing compartments involved after a single course of antenatal betamethasone, prompting additional courses. Four patients stabilized, three improved and two progressed after the second course. The two cases with disease progression underwent an in utero resection. There were one in utero fetal demise and two deaths within the delivery room. Both fetuses that underwent a fetal resection died. All but one mother who delivered a viable fetus had complications of pregnancy.
  
  
  CONCLUSIONS
  Multiple courses of antenatal betamethasone for high-risk fetal CPAMs often result in favorable short-term outcomes without the need for open fetal resection. Pregnancy complications are common and women within this cohort should be monitored closely.
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Derderian
authors.affiliation: Cincinnati Fetal Center, Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Coleman
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Jeanty
authors.affiliation: Cincinnati Fetal Center, Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: F Y
authors.initials: FY
authors.lastname: Lim
authors.affiliation: Cincinnati Fetal Center, Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Shaaban
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Farrell
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: MacKenzie
authors.affiliation: Fetal Treatment Center, Department of Surgery at The University of California, San Francisco, CA, USA. Electronic address: Hanmin.Lee@ucsfmedctr.org.
authors.forename: H
authors.initials: H
authors.lastname: Lee
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage*; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D015619:Respiratory System Abnormalities / Q000150:complications; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone
keywords: CPAM; Congenital cystic adenomatous malformation CCAM; Congenital pulmonary airway malformation; Maternal betamethasone; Prenatal steroids