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Fetus

Poster Session 3

(754) Ultrasound and Clinical Characteristics of Congenital Pulmonary Airway Malformations (CPAM) and Neonatal Care Needs

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: CPAM are a heterogeneous group of congenital abnormalities, with increased prevalence given improvements in ultrasound (US) technology. Clinical factors influence recommendations regarding delivery, but more data is needed to establish a systematic approach to delivery planning. This study aimed to assess the prognostic utility of clinical characteristics to anticipate neonatal support needs.

Study Design:




We performed a retrospective case control study of patients with fetal CPAM from December 2010 to March 2023. The primary outcome was an adverse neonatal outcome composite (NICU admission, neonatal respiratory distress, respiratory support, neonatal surgery, and death). 



Receiver operating characteristic (ROC) curves compared the ability of CPAM volume ratio (CVR) and other US factors to predict the neonatal composite. The Liu method was used to determine a CVR cutoff to predict the neonatal composite outcome. CVR cutoff comparisons were performed by the Fisher exact test for categorical variables and the Mann-Whitney-U test for continuous variables. Statistical significance was defined as P value < 0.05. 










Results:


68 patients were included in the initial analysis, with 18 patients excluded. The composite neonatal outcome was seen in 18 patients (36%). Analysis using ROC curves found that initial, maximum, and final CVR were equally adequate predictors of the neonatal composite outcome. An initial CVR cutoff of 0.8 (sensitivity 50%, specificity 97%, AUC 0.73), maximum CVR cutoff of 0.8 (sensitivity 80%, specificity 70%, AUC 0.75), and final CVR cutoff of 0.4 (sensitivity 65%, specificity 80%, AUC 0.73) optimized ability to predict the neonatal composite outcome.  



Type of lesion and the percent change of CVR over the pregnancy were not predictive of adverse neonatal outcome. Likewise, the gestational age at max CVR and US evidence of compression were poor predictors of the neonatal composite outcome. 






Conclusion: Our study validates the use of CVR to predict outcome and proposes CVR cutoffs that can predict adverse neonatal outcomes and help guide decisions to deliver at a higher level of neonatal care.