Morbidity and Mortality in Neonates with Symptomatic Congenital Lung Malformations: Results from a National Pediatric Administrative Database
Abigail Engwall-Gill1, Jennine H. Weller1, Pooja S. Salvi2, Annalise B. Penikis1, Shelby R. Sferra1, Daniel Rhee1, Daniel Solomon2, Shaun Kunisaki1
1Pediatric Surgery, Johns Hopkins, Odenton, Maryland, United States, 2Pediatric Surgery, Yale, New Haven, Connecticut, United States
Objective: The perioperative course of neonates with symptomatic congenital lung malformations (CLM) is not well described. The goal of this study was to evaluate this cohort by CLM type using a large multicenter database.
Design: Retrospective multicenter cohort study using the Pediatric Health Information System database from 2016-2021
Setting: Comparative database with clinical and resource information from 41 participating children's hospitals in the United States
Patients: Neonates with a symptomatic CLM managed by lung resection.
Interventions: Resection of lung lesion
Main Outcome Measures: postoperative respiratory complications (acute respiratory failure, pneumothorax, pneumonia, reintubation, ventilation for more than 2 days), any complication (respiratory complications, surgical site infection, readmission, related reoperations, extracorporeal membrane oxygenation (ECMO), death, hospital length of stay (LOS)
Results: Of 350 CLM lesions identified, there were 221 symptomatic neonates (pulmonary hypertension, respiratory distress, ventilation, ECMO, or intensive care unit (ICU). There were 125 (57%) congenital pulmonary airway malformations (CPAM), 75 (34%) bronchopulmonary sequestrations (BPS), 6 (3%) congenital lung emphysema, and 20 (9%) hybrid lesions. The majority of the patients were full term (38 weeks) males (54%) who were admitted at birth with a median birthweight of 3090 grams (IQR 2565-3422). Median age of lung resection was 5 days (IQR 2-14) with majority ventilated preoperatively (59%) and 10% ventilated ≥48 hours postoperatively. Fourteen (6%) of patients required ECMO preoperatively and 14 required ECMO postoperatively with 7 BPS cases requiring pre and postoperative ECMO. Overall respiratory complication rate was 70% (n=154), any complication was 78% (n=173), LOS was 23 days (IQR 13, 70), and mortality rate was 10% (n=21) with no significant difference in these outcomes between CLMs (p>0.06). CPAM had the lowest rates of preoperative ventilation (43%, n= 54, p<0.001), preoperative ECMO (0%, p<0.001), preoperative ICU (68%, n=85, p=0.005), and the shortest LOS (17 days, IQR 12-36, p<0.001). BPS was associated with the highest preoperative ECMO (19%, n =13, p<0.001) and postoperative ECMO (16%, n=11, p =0.004).
Conclusion: To our knowledge, this is the first large multicenter descriptive analysis of perioperative characteristics and outcomes of CLMs in symptomatic neonates. These data are useful for pediatric surgeons and neonatologists in counseling families given the prolonged hospitalization and high postoperative complication rates. Although ECMO use is relatively uncommon in this population, neonates with BPS are at the greatest risk of requiring ECMO support.
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