CC BY-NC-ND 4.0 · Journal of Child Science 2017; 07(01): e4-e9
DOI: 10.1055/s-0037-1603772
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Clinical Outcomes in Neonates Undergoing Lung Resection for Congenital Lesions

Hemonta Kumar Dutta
1   Department of Pediatric Surgery, Assam Medical College, Dibrugarh, Assam, India
,
Madhuchanda Bora
2   Department of Anaesthesiology, Assam Medical College, Dibrugarh, Assam, India
,
Diganta Saikia
2   Department of Anaesthesiology, Assam Medical College, Dibrugarh, Assam, India
› Author Affiliations
Further Information

Publication History

09 April 2017

29 April 2017

Publication Date:
21 June 2017 (online)

Abstract

Objective The purpose of this study is to review our experience with neonates and infants with congenital lung lesions emphasizing natural history, management, and outcomes.

Methods A total of 29 neonates and infants presented with congenital lung lesions between 2000 and 2015. Two patients died before surgery due to complications, and one patient refused surgery. Overall, 26 of them were subjected to surgical treatment and were included in the study. Demographic data, indications for surgery, operative procedure, complications, hospital stay, and follow-up were assessed.

Results A total of 26 children aged 5 to 122 days (mean: 35.5 days, 14 males) presented with various congenital lung malformations: congenital lobar emphysema in 10, congenital cystic adenomatous malformation in 8, bronchogenic cyst in 5, and pulmonary sequestration in 3 patients. Respiratory distress and respiratory tract infection were the most common presenting symptoms noted in 22 patients. In three patients the lesion was detected incidentally on chest X-ray. Lobectomy was the most common operation (19/26). Postoperative complications were noted in 12 patients. One patient died due to postoperative sepsis. Postoperative ventilation was required in 24 patients. Patients in the asymptomatic group recovered without any complications. The follow-up period ranged from 3 months to 15 years (median: 76.3 months). Only 12 patients received epidural anesthesia and had a better recovery than the other patients.

Conclusion Congenital lobar emphysema was the most common congenital lung lesion in our series. Respiratory distress and respiratory infection were the most common symptoms. Neonates and infants tolerated lung resection well. Use of epidural anesthesia led to less postoperative complications.

 
  • References

  • 1 Gross RE, Lewis Jr JE. Defects of the anterior mediastinum. Successful surgical repair. Surg Gynecol Obstet 1945; 80: 549-554
  • 2 Rodgers BM. The role of thoracoscopy in pediatric surgical practice. Semin Pediatr Surg 2003; 12 (01) 62-70
  • 3 Kravitz RM. Congenital malformations of the lung. Pediatr Clin North Am 1994; 41 (03) 453-472
  • 4 Stanton M, Davenport M. Management of congenital lung lesions. Early Hum Dev 2006; 82 (05) 289-295
  • 5 Thakral CL, Maji DC, Sajwani MJ. Congenital lobar emphysema: experience with 21 cases. Pediatr Surg Int 2001; 17 (2-3): 88-91
  • 6 Tapper D, Schuster S, McBride J. , et al. Polyalveolar lobe: anatomic and physiologic parameters and their relationship to congenital lobar emphysema. J Pediatr Surg 1980; 15 (06) 931-937
  • 7 Moerman P, Fryns JP, Vandenberghe K, Devlieger H, Lauweryns JM. Pathogenesis of congenital cystic adenomatoid malformation of the lung. Histopathology 1992; 21 (04) 315-321
  • 8 Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 1977; 8 (02) 155-171
  • 9 Dolkart LA, Reimers FT, Helmuth WV, Porte MA, Eisinger G. Antenatal diagnosis of pulmonary sequestration: a review. Obstet Gynecol Surv 1992; 47 (08) 515-520
  • 10 Louie HW, Martin SM, Mulder DG. Pulmonary sequestration: 17-year experience at UCLA. Am Surg 1993; 59 (12) 801-805
  • 11 Wensley DF, Goh TH, Menahem H, Edis B, Venables AW. Management of pulmonary sequestration and Scimitar syndrome presenting in infancy. Pediatr Surg Int 1989; 4: 381-385
  • 12 Mullassery D, Jones MO. Open resections for congenital lung malformations. J Indian Assoc Pediatr Surg 2008; 13 (03) 111-114
  • 13 Rothenberg SS. Thoracoscopic pulmonary surgery. Semin Pediatr Surg 2007; 16 (04) 231-237
  • 14 Adzick NS, Harrison MR, Flake AW, Howell LJ, Golbus MS, Filly RA. Fetal surgery for cystic adenomatoid malformation of the lung. J Pediatr Surg 1993; 28 (06) 806-812
  • 15 Aspirot A, Puligandla PS, Bouchard S, Su W, Flageole H, Laberge JM. A contemporary evaluation of surgical outcome in neonates and infants undergoing lung resection. J Pediatr Surg 2008; 43 (03) 508-512
  • 16 Naito Y, Beres A, Lapidus-Krol E, Ratjen F, Langer JC. Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A prospective study. J Pediatr Surg 2012; 47 (05) 852-856
  • 17 Werner HA, Pirie GE, Nadel HR, Fleisher AG, LeBlanc JG. Lung volumes, mechanics, and perfusion after pulmonary resection in infancy. J Thorac Cardiovasc Surg 1993; 105 (04) 737-742
  • 18 Cook CD, Bucci G. Studies of respiratory physiology in children. IV. The late effects of lobectomy on pulmonary function. Pediatrics 1961; 28: 234-242
  • 19 Frenckner B, Freyschuss U. Pulmonary function after lobectomy for congenital lobar emphysema and congenital cystic adenomatoid malformation. A follow-up study. Scand J Thorac Cardiovasc Surg 1982; 16 (03) 293-298
  • 20 McBride JT, Wohl MEB, Strieder DJ. , et al. Lung growth and airway function after lobectomy in infancy for congenital lobar emphysema. J Clin Invest 1980; 66 (05) 962-970
  • 21 Nakajima C, Kijimoto C, Yokoyama Y. , et al. Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth. Pediatr Surg Int 1998; 13 (5-6): 341-345
  • 22 Keijzer R, Chiu PP, Ratjen F, Langer JC. Pulmonary function after early vs late lobectomy during childhood: a preliminary study. J Pediatr Surg 2009; 44 (05) 893-895
  • 23 Nagata K, Masumoto K, Tesiba R. , et al. Outcome and treatment in an antenatally diagnosed congenital cystic adenomatoid malformation of the lung. Pediatr Surg Int 2009; 25 (09) 753-757
  • 24 Butterworth SA, Blair GK. Postnatal spontaneous resolution of congenital cystic adenomatoid malformations. J Pediatr Surg 2005; 40 (05) 832-834
  • 25 Tsai AY, Liechty KW, Hedrick HL. , et al. Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions. J Pediatr Surg 2008; 43 (03) 513-517
  • 26 Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 2001; 176 (02) 289-296
  • 27 Wong A, Vieten D, Singh S, Harvey JG, Holland AJ. Long-term outcome of asymptomatic patients with congenital cystic adenomatoid malformation. Pediatr Surg Int 2009; 25 (06) 479-485
  • 28 Stanton M, Njere I, Ade-Ajayi N, Patel S, Davenport M. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg 2009; 44 (05) 1027-1033
  • 29 Stacher E, Ullmann R, Halbwedl I. , et al. Atypical goblet cell hyperplasia in congenital cystic adenomatoid malformation as a possible preneoplasia for pulmonary adenocarcinoma in childhood: A genetic analysis. Hum Pathol 2004; 35 (05) 565-570
  • 30 Nasr A, Himidan S, Pastor AC, Taylor G, Kim PC. Is congenital cystic adenomatoid malformation a premalignant lesion for pleuropulmonary blastoma?. J Pediatr Surg 2010; 45 (06) 1086-1089