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

doi:10.1007/s00383-017-4098-z

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

Journal article

Peer reviewed

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, …

Pediatric surgery international, Vol.33(9), pp.939-953

09/2017

DOI: 10.1007/s00383-017-4098-z

PMID: 28589256

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Abstract

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. 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. 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. 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.

Pregnancy

Prenatal Care

Glucocorticoids - therapeutic use

Fetus - surgery

Humans

Prenatal Diagnosis

Pneumonia - prevention & control

Asymptomatic Diseases

Evidence-Based Medicine

Abscess - prevention & control

Advisory Committees

Cystic Adenomatoid Malformation of Lung, Congenital - surgery

Diagnostic Imaging

Pneumonectomy - methods

Societies, Medical

Cell Transformation, Neoplastic

Female

Watchful Waiting

Details

Title: Subtitle: Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee
Creators: Cynthia D Downard - Division of Pediatric Surgery, Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville, 315 East Broadway, Suite 565, Louisville, KY, 40202, USA. C0down01@louisville.edu
Casey M Calkins - Division of Pediatric General and Thoracic Surgery, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
Regan F Williams - Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
Elizabeth J Renaud - Division of Pediatric Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
Tim Jancelewicz - Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
Julia Grabowski - Division of Pediatric Surgery, Department of Surgery, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
Roshni Dasgupta - Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Milissa McKee - Pediatric Surgery, Phoenix, AZ, USA
Robert Baird - Division of Pediatric General and Thoracic Surgery, McGill University Health Center, Montreal Children's Hospital, Glen Site, Montreal, QC, Canada
Mary T Austin - Departments of Surgical Oncology and Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Meghan A Arnold - Division of Pediatric Surgery, Department of Surgery, University of Michigan CS Mott Children's Hospital, Ann Arbor, MI, USA
Adam B Goldin - Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
Julia Shelton - Division of Pediatric Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Saleem Islam - Division of Pediatric Surgery, University of Florida, Gainesville, FL, USA
Resource Type: Journal article
Publication Details: Pediatric surgery international, Vol.33(9), pp.939-953
Publisher: Germany
DOI: 10.1007/s00383-017-4098-z
PMID: 28589256
ISSN: 0179-0358
eISSN: 1437-9813
Grant note: UL1 TR001425 / NCATS NIH HHS
Language: English
Date published: 09/2017
Academic Unit: Stead Family Department of Pediatrics; Surgery
Record Identifier: 9984051568102771

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