Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Inna Lobeck
Presentation Type
Oral Presentation
Start Date
15-5-2026 12:45 PM
End Date
15-5-2026 1:00 PM
Abstract Text
Background: Congenital lung malformations (CLMs) are a heterogeneous group of fetal pulmonary anomalies that may cause significant intrathoracic mass effect, leading to hydrops, pulmonary hypoplasia, and fetal demise. Prenatal interventions are used to mitigate these deleterious effects in severe cases; however, available evidence is limited to small series. Consequently, patient selection, intervention strategy, and the decision to pursue prenatal therapy are largely guided by clinician experience rather than evidence-based consensus.
Objectives/Goal: To characterize contemporary prenatal intervention practices for CLMs across a North American consortium and compare perinatal outcomes between fetuses undergoing prenatal intervention and those with similarly large lesions managed expectantly.
Methods/Design:
We performed a retrospective multicenter cohort study of fetuses with prenatally diagnosed CLMs between 2016 and 2024 across 17 fetal centers. Fetuses undergoing prenatal intervention were compared with fetuses with large lesions (congenital pulmonary airway malformation-volume ratio (CVR) >1.6) managed without prenatal intervention. Outcomes included CVR change, gestational age at birth, survival, need for extracorporeal life support, and postnatal surgery.
Results:
Among 1,756 fetuses with prenatally diagnosed congenital lung malformations, 49 (2.8%) underwent prenatal intervention, demonstrating that fetal therapy was infrequently utilized and reserved for a highly selected subset. The intervention cohort exhibited severe prenatal disease, with a median CPAM-volume ratio (CVR) of 2.49 (IQR 1.38–3.21); hydrops and polyhydramnios were present in over half of cases, indicating significant physiologic compromise. Thoracoamniotic shunting was the most commonly employed intervention and was the only non-resection modality associated with a reduction in lesion size. Despite worse prenatal prognostic indicators, survival to birth and early postnatal outcomes—including need for ventilatory support, extracorporeal life support, and postnatal surgical resection—were similar to those of fetuses with comparably large lesions managed expectantly. No clear association was observed between intervention type and immediate respiratory outcomes at birth.
Conclusions:
Prenatal intervention for congenital lung malformations is rarely required and is selectively applied to fetuses with the most severe physiologic compromise, particularly hydrops and polyhydramnios. Despite markedly worse prenatal risk profiles, fetuses undergoing intervention achieved postnatal outcomes comparable to those of expectantly managed large lesions. These findings suggest that current intervention strategies may mitigate catastrophic disease trajectories rather than confer superior outcomes and highlight substantial practice variability driven by clinician experience. Multicenter data such as these support the need for consensus, physiology-informed guidelines to optimize patient selection and management.
Prenatal Intervention for Congenital Lung Malformations: A Multicenter North American Cohort Study
Background: Congenital lung malformations (CLMs) are a heterogeneous group of fetal pulmonary anomalies that may cause significant intrathoracic mass effect, leading to hydrops, pulmonary hypoplasia, and fetal demise. Prenatal interventions are used to mitigate these deleterious effects in severe cases; however, available evidence is limited to small series. Consequently, patient selection, intervention strategy, and the decision to pursue prenatal therapy are largely guided by clinician experience rather than evidence-based consensus.
Objectives/Goal: To characterize contemporary prenatal intervention practices for CLMs across a North American consortium and compare perinatal outcomes between fetuses undergoing prenatal intervention and those with similarly large lesions managed expectantly.
Methods/Design:
We performed a retrospective multicenter cohort study of fetuses with prenatally diagnosed CLMs between 2016 and 2024 across 17 fetal centers. Fetuses undergoing prenatal intervention were compared with fetuses with large lesions (congenital pulmonary airway malformation-volume ratio (CVR) >1.6) managed without prenatal intervention. Outcomes included CVR change, gestational age at birth, survival, need for extracorporeal life support, and postnatal surgery.
Results:
Among 1,756 fetuses with prenatally diagnosed congenital lung malformations, 49 (2.8%) underwent prenatal intervention, demonstrating that fetal therapy was infrequently utilized and reserved for a highly selected subset. The intervention cohort exhibited severe prenatal disease, with a median CPAM-volume ratio (CVR) of 2.49 (IQR 1.38–3.21); hydrops and polyhydramnios were present in over half of cases, indicating significant physiologic compromise. Thoracoamniotic shunting was the most commonly employed intervention and was the only non-resection modality associated with a reduction in lesion size. Despite worse prenatal prognostic indicators, survival to birth and early postnatal outcomes—including need for ventilatory support, extracorporeal life support, and postnatal surgical resection—were similar to those of fetuses with comparably large lesions managed expectantly. No clear association was observed between intervention type and immediate respiratory outcomes at birth.
Conclusions:
Prenatal intervention for congenital lung malformations is rarely required and is selectively applied to fetuses with the most severe physiologic compromise, particularly hydrops and polyhydramnios. Despite markedly worse prenatal risk profiles, fetuses undergoing intervention achieved postnatal outcomes comparable to those of expectantly managed large lesions. These findings suggest that current intervention strategies may mitigate catastrophic disease trajectories rather than confer superior outcomes and highlight substantial practice variability driven by clinician experience. Multicenter data such as these support the need for consensus, physiology-informed guidelines to optimize patient selection and management.
