Ultrasound assessment of congenital fetal lung masses and neonatal respiratory outcomes.
OBJECTIVE
Fetal congenital lung masses generate concern for compromised postnatal respiratory function. Congenital pulmonary adenomatoid malformation volume ratio (CVR) has been used to predict the risk of hydrops fetalis and need for antenatal intervention. This study investigates whether CVR could be used to predict neonatal respiratory outcomes.


METHODS
The ultrasounds of fetuses diagnosed with a lung mass between 2005 and 2013 were reviewed. CVR was calculated at each ultrasound using the formula for a prolate ellipse divided by head circumference. The pregnancy outcome and information about NICU admission for respiratory insufficiency were collected.


RESULTS
Forty-two fetuses were diagnosed with a lung mass during the study period. CVR prior to 24 weeks and between 24 and 32 weeks were associated with NICU admission (p < 0.0001 and <0.008, respectively). CVR increased up to 32 weeks and decreased thereafter for most subjects. The decrease in CVR beyond 32 weeks was larger for cases that required NICU admission (p = 0.002). For a CVR cut-off of <0.5, the sensitivity was 100%, the specificity 85.7%, and negative predictive value was 100% for regular nursery care.


CONCLUSIONS
In pregnancies diagnosed with fetal lung masses, CVR predicted normal respiratory outcomes and need for NICU admission. This information may be helpful for delivery planning. © 2015 John Wiley & Sons, Ltd.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|Magee-Womens Research Institute, Pittsburgh, PA, USA.
Maisa
M
Feghali
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Katie M
KM
Jean
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|Magee-Womens Research Institute, Pittsburgh, PA, USA.
Stephen P
SP
Emery
D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007384:Intermittent Positive-Pressure Breathing / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000151:congenital* / Q000000981:diagnostic imaging; D011247:Pregnancy; D012119:Respiration; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal