LAUSR

OBJECTIVE Neonatal resection is the mainstay treatment of children presenting with symptomatic congenital lung malformations (CLM) at birth. The objective of this study was to evaluate risk factors for increased morbidity and mortality after neonatal CLM resection using a large multicenter database. STUDY DESIGN Retrospective review of the Pediatric Health Information System database was performed. Children with a symptomatic CLM managed by lung resection before 30 days of age were included (2016-2021). Primary outcome measures were postoperative respiratory complications and any complication, including death. RESULTS Of 1791 CLM patients identified, 256 (14%) underwent neonatal resection for symptomatic disease. Pathology included 123 (48%) congenital pulmonary airway malformations, 24 (10%) bronchopulmonary sequestrations (BPS), 5 (2%) congenital lobar emphysema, 16 (6%) hybrid, and 88 (34%) unclassified lesions. Preoperative mechanical ventilation and extracorporeal membrane oxygenation (ECMO) were employed in 149 (58.2%) and 17 (6.7%) of cases, respectively. The median age at resection was 6.5 days (IQR 2-23). Postoperatively, 25 (10%) required mechanical ventilation for ≥48 hrs, 3 (1%) continued ECMO, and 3 (1%) required ECMO rescue. Overall respiratory complication rate was 34% (n=87), any complication was 51% (n=130), median postoperative length of stay (LOS) was 20 days (IQR 9, 52), and mortality rate was 14.5% (n=37). Birthweight was inversely correlated with complication risk (IRR: 0.55, CI: 0.36-0.83, p=0.006). Cardiac structural anomalies were associated with a 21 day longer postoperative LOS (CI: 6-35, p=0.006) and 2.2 times increased risk of any complication (CI 1.18-4.02, p=0.014). CONCLUSION In this large multicenter study, ECMO use and mortality are relatively uncommon among neonates undergoing lung resection for a symptomatic CLM. However, postoperative morbidity remains high, particularly in those with cardiac structural disease.