Document Detail


High-risk fetal congenital pulmonary airway malformations have a variable response to steroids.
MedLine Citation:
PMID:  19159718     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: Anecdotal reports suggest that maternal steroids may arrest the growth of congenital pulmonary airway malformations (CPAMs), preventing or reversing hydrops. We reviewed our experience with CPAMs to determine the fetal response to steroid therapy. METHODS: This study is a retrospective review of all fetal CPAMs from 2004 to 2008. Fetuses with high-risk CPAMs that received at least one course of steroids were identified. Fetal magnetic resonance imaging and ultrasound data were used to classify the CPAMs, identify hydrops fetalis and follow the fetuses poststeroid dosing. RESULTS: Forty-four fetuses with CPAM were identified. Fifteen patients were found to have received at least one course of steroids. Thirteen were hydropic and 2 were nonhydropic. Seven of the 13 hydropic fetuses (54%) showed an initial response to steroid administration, whereas the 2 nonhydropic high-risk fetuses progressed to birth without developing hydrops. Seven of the 15 patients, however, resulted in fetal demise or early postnatal death, giving a survival rate of 53%. CONCLUSIONS: High-risk CPAMs have a variable response to steroids. This variable response demonstrates the need for a placebo-controlled randomized study to more accurately determine the effect of steroids on hydrops and CPAM growth rates. Repeated steroid courses may not be helpful, and progression in CPAM volume to head circumference ratio (CVR) or hydrops should prompt open fetal surgery to prevent irreversible fetal insult.
Authors:
Lee M Morris; Foong-Yen Lim; Jeffrey C Livingston; William J Polzin; Timothy M Crombleholme
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  44     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-22     Completed Date:  2009-05-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  60-5     Citation Subset:  IM    
Affiliation:
The Fetal Care Center of Cincinnati, Division of Pediatric General Surgery, Cincinnati Children's Hospital, OH 45229-3039, USA.
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MeSH Terms
Descriptor/Qualifier:
Betamethasone / therapeutic use*
Chi-Square Distribution
Cystic Adenomatoid Malformation of Lung, Congenital / drug therapy*
Female
Fetal Diseases / drug therapy*
Humans
Hydrops Fetalis / drug therapy*
Pregnancy
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
378-44-9/Betamethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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