TY - JOUR
T1 - Establishment of a multidisciplinary fetal center streamlines approach for congenital lung malformations
AU - Reyna, Juan C.
AU - Zagory, Jessica A.
AU - Yallapragada, Sushmita
AU - Santiago-Munoz, Patricia
AU - Schindel, David T.
N1 - Publisher Copyright:
© 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022
Y1 - 2022
N2 - Purpose: Fetuses with a diagnosis of congenital lung malformations (CLM) on prenatal imaging are commonly referred to a multi-disciplinary specialty team for prenatal assessment and postnatal management. The net effect of such services is broadly stated to improve the outcomes of affected newborns. However, these claims are relatively unsubstantiated. Methods: After IRB approval, a retrospective review of children diagnosed with CLM from 2008 to 2018 and referred to a large urban children’s hospital was performed. A comparison was performed between prenatally diagnosed patients having a multi-disciplinary fetal center evaluation (FC) and prenatally diagnosed patients who did not receive a referral or were seen prior to the establishment of the center (NON-FC). Results: Eighty-eight live-born patients with a prenatal diagnosis of CLM were identified, with 49 in the FC group and 39 NON-FC. Thirty-four (63%) and 23 (59%) patients underwent operative resection of CLM, respectively. FC patients presented earlier at first postnatal follow-up (42 vs. 145 days, p =.03), had fewer preoperative office visits (2.1 vs. 3.4, p =.0003), received fewer preoperative chest radiographs (0.5 vs. 1.3; p =.002) and chest computed tomography (0.9 vs. 1.4; p =.001), and had fewer preoperative pneumonias (0 vs. 17.4%; p =.02) compared to their NON-FC counterparts. FC patients were also more likely to undergo resection at an earlier age (217 vs. 481 days, p =.003) and were more likely to undergo a minimally invasive resection (75% vs. 39.1%, p =.015). There were no differences in post-operative outcomes between the two groups. Conclusion: Children with a prenatal diagnosis of CLM appear to benefit from an organized multi-specialty team approach in several impactful parameters. Hospital systems and providers that invest in similar strategies are likely to achieve improved outcomes in the care of newborns prenatally diagnosed with a CLM.
AB - Purpose: Fetuses with a diagnosis of congenital lung malformations (CLM) on prenatal imaging are commonly referred to a multi-disciplinary specialty team for prenatal assessment and postnatal management. The net effect of such services is broadly stated to improve the outcomes of affected newborns. However, these claims are relatively unsubstantiated. Methods: After IRB approval, a retrospective review of children diagnosed with CLM from 2008 to 2018 and referred to a large urban children’s hospital was performed. A comparison was performed between prenatally diagnosed patients having a multi-disciplinary fetal center evaluation (FC) and prenatally diagnosed patients who did not receive a referral or were seen prior to the establishment of the center (NON-FC). Results: Eighty-eight live-born patients with a prenatal diagnosis of CLM were identified, with 49 in the FC group and 39 NON-FC. Thirty-four (63%) and 23 (59%) patients underwent operative resection of CLM, respectively. FC patients presented earlier at first postnatal follow-up (42 vs. 145 days, p =.03), had fewer preoperative office visits (2.1 vs. 3.4, p =.0003), received fewer preoperative chest radiographs (0.5 vs. 1.3; p =.002) and chest computed tomography (0.9 vs. 1.4; p =.001), and had fewer preoperative pneumonias (0 vs. 17.4%; p =.02) compared to their NON-FC counterparts. FC patients were also more likely to undergo resection at an earlier age (217 vs. 481 days, p =.003) and were more likely to undergo a minimally invasive resection (75% vs. 39.1%, p =.015). There were no differences in post-operative outcomes between the two groups. Conclusion: Children with a prenatal diagnosis of CLM appear to benefit from an organized multi-specialty team approach in several impactful parameters. Hospital systems and providers that invest in similar strategies are likely to achieve improved outcomes in the care of newborns prenatally diagnosed with a CLM.
KW - Cystic lung malformation
KW - multidisciplinary care
KW - outcomes
KW - prenatal diagnosis
KW - surgery
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U2 - 10.1080/14767058.2020.1811667
DO - 10.1080/14767058.2020.1811667
M3 - Article
C2 - 32847439
AN - SCOPUS:85089890890
SN - 1476-7058
VL - 35
SP - 2883
EP - 2888
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 15
ER -