Prenatal steroids for microcystic congenital cystic adenomatoid malformations

Patrick F. Curran, Eric B. Jelin, Larry Rand, Shinjiro Hirose, Vickie A. Feldstein, Ruth B. Goldstein, Hanmin Lee

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Objective: The purpose of this study is to evaluate the effect of prenatal steroid treatment in fetuses with sonographically diagnosed congenital cystic adenomatoid malformations (CCAMs). Methods: This was an institutional review board-approved retrospective review of 372 patients referred to the University of California, San Francisco (UCSF), for fetal CCAM. Inclusion criteria were (1) a predominately microcystic CCAM lesion sonographically diagnosed at our institution, (2) maternal administration of a single course of prenatal corticosteroids (betamethasone), and (3) no fetal surgery. CCAM volume-to-head ratio (CVR), presence of hydrops, mediastinal shift, and diaphragm eversion were assessed before and after administration of betamethasone. The primary end points were survival to birth and neonatal discharge. Results: Sixteen patients with predominantly microcystic CCAMs were treated with prenatal steroids. Three were excluded because of lack of follow-up information. All remaining fetuses (13/13) survived to delivery and 11/13 (84.6%) survived to neonatal discharge. At the time of steroid administration, all patients had CVR greater than 1.6, and 9 (69.2%) also had nonimmune hydrops fetalis. After a course of steroids, CVR decreased in 8 (61.5%) of the 13 patients, and hydrops resolved in 7 (77.8%) of the 9 patients with hydrops. The 2 patients whose hydrops did not resolve with steroid treatment did not survive to discharge. Conclusion: In high-risk fetal patients with predominantly microcystic CCAM lesions, betamethasone is an effective treatment. This series is a pilot study for a prospective randomized trial comparing treatment of CCAM with betamethasone to placebo.

Original languageEnglish (US)
Pages (from-to)145-150
Number of pages6
JournalJournal of Pediatric Surgery
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Congenital Cystic Adenomatoid Malformation of Lung
Steroids
Betamethasone
Edema
Head
Fetus
Hydrops Fetalis
San Francisco
Research Ethics Committees
Therapeutics
Diaphragm
Adrenal Cortex Hormones
Placebos
Mothers
Parturition
Survival

Keywords

  • Betamethasone
  • CCAM
  • Congenital cystic adenomatoid malformation
  • Fetal surgery
  • Hydrops fetalis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Curran, P. F., Jelin, E. B., Rand, L., Hirose, S., Feldstein, V. A., Goldstein, R. B., & Lee, H. (2010). Prenatal steroids for microcystic congenital cystic adenomatoid malformations. Journal of Pediatric Surgery, 45(1), 145-150. https://doi.org/10.1016/j.jpedsurg.2009.10.025

Prenatal steroids for microcystic congenital cystic adenomatoid malformations. / Curran, Patrick F.; Jelin, Eric B.; Rand, Larry; Hirose, Shinjiro; Feldstein, Vickie A.; Goldstein, Ruth B.; Lee, Hanmin.

In: Journal of Pediatric Surgery, Vol. 45, No. 1, 01.01.2010, p. 145-150.

Research output: Contribution to journalArticle

Curran, PF, Jelin, EB, Rand, L, Hirose, S, Feldstein, VA, Goldstein, RB & Lee, H 2010, 'Prenatal steroids for microcystic congenital cystic adenomatoid malformations', Journal of Pediatric Surgery, vol. 45, no. 1, pp. 145-150. https://doi.org/10.1016/j.jpedsurg.2009.10.025
Curran, Patrick F. ; Jelin, Eric B. ; Rand, Larry ; Hirose, Shinjiro ; Feldstein, Vickie A. ; Goldstein, Ruth B. ; Lee, Hanmin. / Prenatal steroids for microcystic congenital cystic adenomatoid malformations. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 1. pp. 145-150.
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abstract = "Objective: The purpose of this study is to evaluate the effect of prenatal steroid treatment in fetuses with sonographically diagnosed congenital cystic adenomatoid malformations (CCAMs). Methods: This was an institutional review board-approved retrospective review of 372 patients referred to the University of California, San Francisco (UCSF), for fetal CCAM. Inclusion criteria were (1) a predominately microcystic CCAM lesion sonographically diagnosed at our institution, (2) maternal administration of a single course of prenatal corticosteroids (betamethasone), and (3) no fetal surgery. CCAM volume-to-head ratio (CVR), presence of hydrops, mediastinal shift, and diaphragm eversion were assessed before and after administration of betamethasone. The primary end points were survival to birth and neonatal discharge. Results: Sixteen patients with predominantly microcystic CCAMs were treated with prenatal steroids. Three were excluded because of lack of follow-up information. All remaining fetuses (13/13) survived to delivery and 11/13 (84.6{\%}) survived to neonatal discharge. At the time of steroid administration, all patients had CVR greater than 1.6, and 9 (69.2{\%}) also had nonimmune hydrops fetalis. After a course of steroids, CVR decreased in 8 (61.5{\%}) of the 13 patients, and hydrops resolved in 7 (77.8{\%}) of the 9 patients with hydrops. The 2 patients whose hydrops did not resolve with steroid treatment did not survive to discharge. Conclusion: In high-risk fetal patients with predominantly microcystic CCAM lesions, betamethasone is an effective treatment. This series is a pilot study for a prospective randomized trial comparing treatment of CCAM with betamethasone to placebo.",
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