Morbidity and Mortality in Neonates with Symptomatic Congenital Lung Malformation.

Autor:	Engwall-Gill AJ; From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)., Weller JH; From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)., Salvi PS; the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki)., Penikis AB; From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)., Sferra SR; From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)., Rhee DS; From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)., Solomon DG; the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki)., Kunisaki SM; the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki).
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2023 Jun 01; Vol. 236 (6), pp. 1139-1146. Date of Electronic Publication: 2023 Feb 14.
DOI:	10.1097/XCS.0000000000000653
Abstrakt:	Background: Neonatal resection is the mainstay treatment of children presenting with symptomatic congenital lung malformation (CLM) at birth. The objective of this study was to evaluate risk factors for increased morbidity and mortality after neonatal CLM resection using a large multicenter database. Study Design: Retrospective review of the Pediatric Health Information System database was performed. Children with a symptomatic CLM managed by lung resection before 30 days of age were included (2016 to 2021). Primary outcomes measures were postoperative respiratory complication and any complication, including death. Results: Of 1,791 CLM patients identified, 256 (14%) underwent neonatal resection for symptomatic disease. Pathology included 123 (48%) congenital pulmonary airway malformation, 24 (10%) bronchopulmonary sequestration, 5 (2%) congenital lobar emphysema, 16 (6%) hybrid, and 88 (34%) unclassified lesion. Preoperative mechanical ventilation and extracorporeal membrane oxygenation (ECMO) were employed in 149 (58.2%) and 17 (6.7%) of cases, respectively. The median age at resection was 6.5 days (interquartile range 2 to 23). Postoperatively, 25 (10%) required mechanical ventilation for 48 hours or more, 3 (1%) continued ECMO, and 3 (1%) required ECMO rescue. The overall respiratory complication rate was 34% (87), rate of any complication was 51% (130), median postoperative length of stay was 20 days (interquartile range 9 to 52), and mortality rate was 14.5% (37). Birthweight was inversely correlated with complication risk (incidence rate ratio 0.55, 95% CI 0.36 to 0.83, p = 0.006). Cardiac structural anomaly was associated with a 21-day longer postoperative length of stay (95% CI 6 to 35, p = 0.006) and 2.2 times increased risk of any complication (95% CI 1.18 to 4.02, p = 0.014). Conclusions: In this large multicenter study, ECMO use and mortality are relatively uncommon among neonates undergoing lung resection for a symptomatic CLM. However, postoperative morbidity remains high, particularly in those with cardiac structural disease. (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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