Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee

Cynthia D. Downard*, Casey M. Calkins, Regan F. Williams, Elizabeth J. Renaud, Tim Jancelewicz, Julia Grabowski, Roshni Dasgupta, Milissa McKee, Robert Baird, Mary T. Austin, Meghan A. Arnold, Adam B. Goldin, Julia Shelton, Saleem Islam

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Purpose: Variation in management characterizes treatment of infants with a congenital pulmonary airway malformation (CPAM). This review addresses six clinically applicable questions using available evidence to provide recommendations for the treatment of these patients. Methods: Questions regarding the management of a pediatric patient with a CPAM were generated. English language articles published between 1960 and 2014 were compiled after searching Medline and OvidSP. The articles were divided by subject area and by the question asked, then reviewed and included if they specifically addressed the proposed question. Results: 1040 articles were identified on initial search. After screening abstracts per eligibility criteria, 130 articles were used to answer the proposed questions. Based on the available literature, resection of an asymptomatic CPAM is controversial, and when performed is usually completed within the first six months of life. Lobectomy remains the standard resection method for CPAM, and can be performed thoracoscopically or via thoracotomy. There is no consensus regarding a monitoring protocol for observing asymptomatic lesions, although at least one chest computerized tomogram (CT) should be performed postnatally for lesion characterization. An antenatally identified CPAM can be evaluated with MRI if fetal intervention is being considered, but is not required for the fetus with a lesion not at risk for hydrops. Prenatal consultation should be offered for infants with CPAM and encouraged for those infants in whom characteristics indicate risk of hydrops. Conclusions: Very few articles provided definitive recommendations for care of the patient with a CPAM and none reported Level I or II evidence. Based on available information, CPAMs are usually resected early in life if at all. A prenatally diagnosed congenital lung lesion should be evaluated postnatally with CT, and prenatal counseling should be undertaken in patients at risk for hydrops.

Original languageEnglish (US)
Pages (from-to)939-953
Number of pages15
JournalPediatric Surgery International
Volume33
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • Adenomatoid
  • CPAM
  • Congenital
  • Fetal
  • Lung
  • Pulmonary
  • Systematic review

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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