• Isabelle Ruchonnet-Metrailler, Elise Leroy-Terquem, Julien Stirnemann, Pierrick Cros, Héloïse Ducoin, Alice Hadchouel, Naziha Khen-Dunlop, André Labbé, Géraldine Labouret, Marie-Noëlle Lebras, Guillaume Lezmi, Fouad Madhi, Laurent J Salomon, Guillaume Thouvenin, Caroline Thumerelle, and Christophe Delacourt.
• Pneumologie Pédiatrique, Necker, AP-HP, France; Centre de Référence des Maladies Respiratoires Rares, Paris, France;
• Pediatrics. 2014 May 1;133(5):e1285-91.

Background And ObjectiveCongenital pulmonary malformations (CPM) are mostly recognized on prenatal ultrasound scans. In a minority of cases, they may impair breathing at birth. The factors predictive of neonatal respiratory distress are not well defined, but an understanding of these factors is essential for decisions concerning the need for the delivery to take place in a tertiary care center. The aim of this study was to identify potential predictors of respiratory distress in neonates with CPM.MethodsWe selected cases of prenatal diagnosis of hyperechoic and/or cystic lung lesions from RespiRare, the French prospective multicenter registry for liveborn children with rare respiratory diseases (2008-2013). Prenatal parameters were correlated with neonatal respiratory outcome.ResultsData were analyzed for 89 children, 22 (25%) of whom had abnormal breathing at birth. Severe respiratory distress, requiring oxygen supplementation or ventilatory support, was observed in 12 neonates (13%). Respiratory distress at birth was significantly associated with the following prenatal parameters: mediastinal shift (P = .0003), polyhydramnios (P = .05), ascites (P = .0005), maximum prenatal malformation area (P = .001), and maximum congenital pulmonary malformation volume ratio (CVR) (P = .001). Severe respiratory distress, requiring oxygen at birth, was best predicted by polyhydramnios, ascites, or a CVR >0.84.ConclusionsCVR >0.84, polyhydramnios, and ascites increased the risk of respiratory complications at birth in fetuses with CPM, and especially of severe respiratory distress, requiring oxygen supplementation or more intensive intervention. In such situations, the delivery should take place in a tertiary care center.Copyright © 2014 by the American Academy of Pediatrics.

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