Morris et al.1313 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. Doi: 10.1016/j.jpedsurg.2008.10.012 https://doi.org/10.1016/j.jpedsurg.2008....
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Retrospective review |
Review the experience with CPAMs to determine the fetal response to steroid therapy |
Cincinnati, OH, USA |
Fetuses diagnosed with high-risk CPAM and treated with at least one course of betamethasone |
44 with CPAM, of which 15 were selected to receive at least one dose of corticosteroids |
● Thirteen were hydropic and 2 were nonhydropic. ● Seven of the 13 hydropic fetuses (54%) shown an initial response to steroid administration, whereas the 2 nonhydropic high-risk fetuses progressed to birth without developing hydrops. ● Seven of 15 patients, however, resulted in the fetal demise or early postnatal death, giving a survival rate of 53%. |
Curran et al.1414 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. Doi: 10.1016/j.jpedsurg.2009.10.025 https://doi.org/10.1016/j.jpedsurg.2009....
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Retrospective review |
Evaluate the effect of prenatal steroid treatment in fetuses with sonographically diagnosed CPAM |
San Francisco, CA,USA |
Patients with a diagnosis of fetal CPAM with a predominatelymicrocystic lesion and not submitted to a fetal surgical intervention for CPA and who received maternal administration of a single course ofprenatal steroids |
Sixteen pregnancies with predominately microcysticCPAM treated with a single course of prenatal steroids (3 were excluded because of lack of follow-up information. |
● All 13 fetuses survived to delivery and 11 survived to neonatal discharge. ● At the time of steroid administration, all patients had CVR greater than 1,6, and 9 of them also had nonimmune hydrops fetalis. ● After a course of steroids, CVR decreased in 8 of the 13 patients, and hydrops resolved in 7 of the 9 patients with hydrops.● The 2 patients whose hydrops did not resolve with steroid treatment did not survive to discharge. |
Peranteau et al.1515 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. Doi: 10.1016/j.jpedsurg.2015.10.018 https://doi.org/10.1016/j.jpedsurg.2015....
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Retrospective review |
Present theexperience with the management fetuses with large congenital lunglesions receiving multiple courses of maternal BMZ and provide anupdate on the response of those receiving a single course. |
Philadelphia, PA,USA |
Fetuses with congenital lung lesions managed with maternal BMZ |
Forty-three patients were managed with prenatal steroids (28 with single course and 15 with multiple courses) |
● Single course recipients demonstrated a reduction in lesion size and resolution of hydrops in 82% and 88% of patients respectively compared with 47% and 56% in recipients of multiple steroid courses. ● Survival of multiple course patients (86%) was comparable to that of single course patients (93%) and improved compared with non-treated historical controls. ● Multiple course recipients demonstrated an increased need for open fetal surgery and postnatal surgery at a younger age. |
Derderian et al.1616 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. Doi: 10.1016/j.jpedsurg.2014.08.019 https://doi.org/10.1016/j.jpedsurg.2014....
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Retrospective review |
Review treatment approaches and outcomes of fetuses who received multiple courses of maternal betamethasone at two tertiary fetal treatment centers. |
Cincinnati, OH, and San Francisco, CA,USA |
Patients treated with multiple courses of prenatal steroids for high-risk CPAMs |
Eight patients with high-risk CPAM |
● All patients (9) but one either had an increased CVR or number of fluid-containing compartments involved after a single course of antenatal betamethasone, prompting additional courses. ● Four patients stabilized, three improved and two progressed after the second course. ● The two cases with disease progression underwent an in utero resection. ● There were one in utero fetal demise and two deaths within the delivery room. Both fetuses that underwent a fetal resection died. ● All but one mother who delivered a viable fetus had complications of pregnancy. |