Short- and long-term outcome after fetal therapy for thoracic abnormalities

Abstract

Fetal thoracic

abnormalities such as congenital cystic adenomatoid malformation of the lung

(CCAM), bronchopulmonary sequestration (BPS) and fetal pleural effusions (FPE)

can lead to fetal hydrops due to their space occupying effect. In these cases the risk of fetal demise is very high when left untreated. Different treatment modalities are available to reduce the intrathoracic pressure either by directly reducing the mass of the lesion (e.g. by laser coagulation of the feeding vessel of BPS) or by shunt placement in FPE or macrocystic CCAM. These treatments reduce perinatal mortality. Infants born after fetal therapy are at increased risk of neonatal morbidity and mortality. The rates of respiratory failure at birth and postnatal demise are highest in the group treated for CCAM with hydrops. In patients with BPS and hydrops the rates of neonatal morbidity and demise are lower. The postnatal course of hydropic fetuses treated with thoracoamniotic shunt for isolated hydrothorax is often complicated by respiratory failure and persistent pleural effusions. Neonatal survival is good provided delivery occurs at or after 32 weeks’ gestation. In these groups of patients severe neurodevelopmental impairment (NDI) at long-term follow-up was detected in 15% of cases.