title: Pulmonary Malformations: Predictors of Neonatal Respiratory Distress and Early Surgery.
abstract: OBJECTIVE
  The objective of our study is to retrospectively analyze a single-centre series of antenatally detected pulmonary malformations (PM) and to evaluate their postnatal outcome.
  
  
  METHODS
  We retrospectively reviewed all prenatally diagnosed PM patients referred to our Centre in the period between January 1999 and December 2014. All cases were diagnosed by one of our Maternal-Fetal Specialists by US examination. Congenital pulmonary airway malformation (CPAM) volume ratio (CVR), development of fetal complications, need for fetal therapy, need for neonatal resuscitation and timing of surgery were analyzed.
  
  
  RESULTS
  A total of 70 fetuses were diagnosed with a PM in the period of study. An initial CVR higher than 1.6 was found in 16/70 patients (22.8%); 14/16 developed fetal complications (p less than .0001). Fifty-six fetuses (80%) did not develop any complications during pregnancy. To all complicated cases a prenatal treatment was offered, carried out in 12 (1 termination, 1 refusal). Survival rate was 100%. Sixty-three fetuses (90%) were asymptomatic at birth and did not require any neonatal resuscitation. Six patients submitted to fetal therapy and one untreated presented with neonatal respiratory distress, required mechanical ventilation at birth and early surgery in the neonatal period (7/70, 10%).
  
  
  CONCLUSIONS
  CVR > 1.6 and the presence of fetal complications can be considered as predictors of respiratory distress at birth and of the need for early surgery. Nevertheless, the vast majority of PM are asymptomatic at birth and only a small group of fetuses require prenatal and postnatal treatment and support.
authors.affiliation: Department of Pediatric Surgery, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Costanzo
authors.affiliation: Department of Pediatric Surgery, V. Buzzi Children's Hospital, Milano, Italy ; Department of Surgery, PhD School of Experimental Medicine, University of Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filisetti
authors.affiliation: Department of Pediatric Surgery, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vella
authors.affiliation: Maternal-Fetal Department, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Rustico
authors.affiliation: Neonatal Intensive Care Unit, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Fontana
authors.affiliation: Neonatal Intensive Care Unit, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: Radiology Department, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Zirpoli
authors.affiliation: Radiology Department, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Napolitano
authors.affiliation: Department of Pediatric Surgery, V. Buzzi Children's Hospital, Milano, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Riccipetitoni
keywords: CPAM volume ratio; Fetal therapy; Neonatal resuscitation; Prenatal diagnosis; Pulmonary malformations