Use of Corticosteroids in Prenatal Treatment of Congenital Pulmonary Adenomatoid Malformation: Integrative Review

Abstract

Objective To review data on the use of corticosteroids for the treatment of fetuses with high-risk congenital pulmonary adenomatoid malformation (CPAM).

Methods Integrative review based on the literature available on MEDLINE and LILACS, including articles published until November, 2020.

Results The initial search resulted in 87 articles, 4 of which were selected for analysis, with all of them being retrospective descriptive observational studies. In the group of fetuses that received only a single corticosteroid cycle, the hydrops resolution rate was 70%, and the survival rate was 83.8%. In fetuses treated with 2 or more cycles of corticosteroids, there was an improvement in the condition of hydrops or edema in a single body compartment in 47%, and survival of 81.8% of the fetuses.

Conclusion The use of corticosteroids for the prenatal treatment of high-risk CPAM appears to be associated with an improvement in perinatal outcomes.

Resumo

Objetivo Revisar os dados sobre o uso de corticoide no tratamento de fetos com malformação adenomatoide pulmonar congênita (MAPC) de alto risco.

Métodos Revisão integrativa com base na literatura disponível no MEDLINE e LILACS, incluindo artigos publicados até novembro de 2020.

Resultados A busca inicial resultou em 87 artigos, dos quais 4 foram selecionados para análise, todos tratando-se de estudos observacionais descritivos retrospectivos. No grupo de fetos que recebeu apenas um único ciclo de corticosteroide, a taxa de resolução da hidropsia foi de 70% e a taxa de sobrevida de 83,8%. Em fetos tratados com 2 ou mais ciclos de corticosteroides, houve melhora do quadro de hidropsia ou edema em um único compartimento corporal em 47% dos fetos e taxa de sobrevida de 81,8%.

Conclusão O uso de corticosteroides para o tratamento pré-natal da MAPC de alto risco parece estar associado à melhora dos resultados perinatais.

Keywords

congenital pulmonary adenomatoid malformation - fetal treatment - corticosteroid - betamethasone - hydrops

Palavras-chave

malformação adenomatoide pulmonar congenital - tratamento fetal - corticosteroide - betametasona - hidropsia

• References

• 1 Wilson RD, Hedrick HL, Liechty KW, Flake AW, Johnson MP, Bebbington M. et al. Cystic adenomatoid malformation of the lung: review of genetics, prenatal diagnosis, and in utero treatment. Am J Med Genet A 2006; 140 (02) 151-155
• 2 Azizkhan RG, Crombleholme TM. Congenital cystic lung disease: contemporary antenatal and postnatal management. Pediatr Surg Int 2008; 24 (06) 643-657
• 3 Duncombe GJ, Dickinson JE, Kikiros CS. Prenatal diagnosis and management of congenital cystic adenomatoid malformation of the lung. Am J Obstet Gynecol 2002; 187 (04) 950-954
• 4 Laje P, Liechty KW. Postnatal management and outcome of prenatally diagnosed lung lesions. Prenat Diagn 2008; 28 (07) 612-618
• 5 Cass DL, Quinn TM, Yang EY, Liechty KW, Crombleholme TM, Flake AW. et al. Increased cell proliferation and decreased apoptosis characterize congenital cystic adenomatoid malformation of the lung. J Pediatr Surg 1998; 33 (07) 1043-1046 , discussion 1047
• 6 Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 1977; 8 (02) 155-171
• 7 Schwartz DS, Reyes-Mugica M, Keller MS. Imaging of surgical diseases of the newborn chest. Intrapleural mass lesions. Radiol Clin North Am 1999; 37 (06) 1067-1078 , v
• 8 Adzick NS, Flake AW, Crombleholme TM. Management of congenital lung lesions. Semin Pediatr Surg 2003; 12 (01) 10-16
• 9 Crombleholme TM, Coleman B, Hedrick H, Liechty K, Howell L, Flake AW. et al. Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg 2002; 37 (03) 331-338
• 10 Vu L, Tsao K, Lee H, Nobuhara K, Farmer D, Harrison M. et al. Characteristics of congenital cystic adenomatoid malformations associated with nonimmune hydrops and outcome. J Pediatr Surg 2007; 42 (08) 1351-1356
• 11 Tsao K, Hawgood S, Vu L, Hirose S, Sydorak R, Albanese CT. et al. Resolution of hydrops fetalis in congenital cystic adenomatoid malformation after prenatal steroid therapy. J Pediatr Surg 2003; 38 (03) 508-510
• 12 Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein (Sao Paulo) 2010; 8 (1 Pt 1): 102-106
• 13 Morris LM, Lim FY, Livingston JC, Polzin WJ, Crombleholme TM. High-risk fetal congenital pulmonary airway malformations have a variable response to steroids. J Pediatr Surg 2009; 44 (01) 60-65
• 14 Curran PF, Jelin EB, Rand L, Hirose S, Feldstein VA, Goldstein RB. et al. Prenatal steroids for microcystic congenital cystic adenomatoid malformations. J Pediatr Surg 2010; 45 (01) 145-150
• 15 Peranteau WH, Boelig MM, Khalek N, Moldenhauer JS, Martinez-Poyer J, Hedrick HL. et al. Effect of single and multiple courses of maternal betamethasone on prenatal congenital lung lesion growth and fetal survival. J Pediatr Surg 2016; 51 (01) 28-32
• 16 Derderian SC, Coleman AM, Jeanty C, Lim FY, Shaaban AM, Farrell JA. et al. Favorable outcomes in high-risk congenital pulmonary airway malformations treated with multiple courses of maternal betamethasone. J Pediatr Surg 2015; 50 (04) 515-518