Tratamento cirúrgico das malformações broncopulmonares em crianças: influência do diagnóstico intrauterino na evolução pós-natal

Abstract

Introduction: Congenital bronchopulmonary malformations (BPM) include a spectrum of diseases regarding anomalous development of the lower respiratory tract. They are classified as congenital pulmonary airway malformations (CPAM), bronchogenic cyst (BC), bronchopulmonary sequestration (BPS) or congenital lobar emphysema (CLE). Although described as rare, they are considered more prevalent. Currently, intrauterine diagnosis is more frequent. However, it is still unknown the influence of prenatal diagnosis on the clinical course of these children after birth. Objective: To describe the experience with surgical treatment of BPM and to evaluate the postnatal influence of intrauterine diagnosis in a tertiary referral hospital. Method: A retrospective analysis of medical records was performed, including children aged 0 to 18 years old, operated due to BPM in a HC-UFMG/EBSERH, between 2000 and 2021. According to time of diagnosis, children were divided in two groups: pre or postnatal. A comparative analysis of these groups was carried out regarding surgical age, occurrence of pneumonia prior to the operation, histological type of BPM and surgical outcomes: postoperative complications, duration of mechanical ventilation, chest drainage, length of hospital stay (LOS) and type of BPM. Results: A total of 66 children were included. Of them, 43 (65.2%) had prenatal diagnosis of BPM and in 23 (34,8%) the diagnosis was done after the birth. 41 (62.1%) were asymptomatic at birth, 20 (30.3%) had at least one episode of pneumonia before the operation, 40 (60.6%) were diagnosed with CPAM and 28 (42.4%) had at least one postoperative complication. Children with intrauterine diagnosis had 13.5 (95% CI: 3.5 to 62.6) times the chance of not having pneumonia prior to the operation (p value <0.001) and were operated on at a mean age of 6.6 months. The remaining 23 (34.8%) children with postnatal diagnosis of BPM were operated on at the age of 2.7 years (p<0.001) on average. No association was observed between the time of diagnosis and postoperative outcomes. Among the children who were born asymptomatic, those operated on younger than 30 days had a median LOS of 8 days longer than those who operated older than 366 days (95% CI: 1.0 to 13.0). Only 1 (1.51%) patient of the entire series died. Conclusion: Although not influencing postoperative outcomes, prenatal diagnosis of BPM is associated with earlier surgical interventions and lower risk of pneumonia prior to the operation. Pulmonary lobectomy is well tolerated in children with BPM even before the first year of life.