From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee).
the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki).
J Am Coll Surg. 2023 Jun 1;236(6):1139-1146. doi: 10.1097/XCS.0000000000000653. Epub 2023 Feb 14.
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.
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.
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).
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.
新生儿切除术是治疗出生时患有症状性先天性肺畸形（CLM）患儿的主要治疗方法。本研究的目的是使用大型多中心数据库评估新生儿 CLM 切除术后发病率和死亡率增加的危险因素。
对儿科健康信息系统数据库进行回顾性分析。纳入在 30 天龄前接受肺切除术治疗有症状 CLM 的患儿（2016 年至 2021 年）。主要结局指标为术后呼吸并发症和任何并发症，包括死亡。
在 1791 例 CLM 患儿中，256 例（14%）因症状性疾病行新生儿切除术。病理包括 123 例（48%）先天性肺气道畸形、24 例（10%）支气管肺隔离症、5 例（2%）先天性大叶性肺气肿、16 例（6%）混合型和 88 例（34%）未分类病变。149 例（58.2%）和 17 例（6.7%）患儿分别接受术前机械通气和体外膜肺氧合（ECMO）治疗。中位切除术年龄为 6.5 天（四分位间距 2 至 23）。术后 25 例（10%）需要机械通气 48 小时或更长时间，3 例（1%）继续 ECMO，3 例（1%）需要 ECMO 抢救。总体呼吸并发症发生率为 34%（87 例），任何并发症发生率为 51%（130 例），术后中位住院时间为 20 天（四分位间距 9 至 52），死亡率为 14.5%（37 例）。出生体重与并发症风险呈负相关（发病率比 0.55，95%CI 0.36 至 0.83，p = 0.006）。心脏结构异常与术后住院时间延长 21 天（95%CI 6 至 35，p = 0.006）和任何并发症风险增加 2.2 倍相关（95%CI 1.18 至 4.02，p = 0.014）。
在这项大型多中心研究中，接受肺切除术治疗有症状 CLM 的新生儿 ECMO 使用和死亡率相对较低。然而，术后发病率仍然很高，特别是在有心脏结构疾病的患儿中。
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