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Postnatal management of asymptomatic congenital pulmonary malformations: moving towards evidence-based decisions
  1. Christophe Delacourt1,2
  1. 1 Pneumologie Pédiatrique, APHP, Hôpital Necker-Enfants Malades, Paris, France
  2. 2 Faculty of Medicine, Université Paris-Descartes, Paris, France
  1. Correspondence to Professor Christophe Delacourt, Service de Pneumologie Pédiatrique, Hôpital Necker-Enfants Malades, 149-161 rue de Sèvres, 75015 Paris; christophe.delacourt{at}nck.aphp.fr

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The prenatal diagnosis of most cases of congenital pulmonary malformations (CPMs) has revolutionised our view of these malformations. Before it became possible to diagnose these malformations prenatally, they were generally discovered as a result of complications. With the increasing rate of prenatal diagnosis, it has become clear that the vast majority of CPMs are actually asymptomatic. Most surgical teams initially insisted on the systematic surgical removal of these asymptomatic CPMs to prevent complications in the short or long term. These complications, such as infection, bleeding and malignant transformation, were considered to be sufficiently frequent and/or severe to justify preventive surgical excision. However, the advent of prenatal diagnosis also made it possible to evaluate outcome in a series of children with CPM, including asymptomatic cases, improving our understanding of the natural course of CPM and calling into question the systematic recourse to surgery. The paper by Cook et al 1 in this issue further extends our knowledge. It describes the outcome of 119 children with prenatally diagnosed CPM followed at a single centre for a median of 9.9 years. Most of the results for this series confirm those reported in previous publications. First, severe neonatal complications are rare, with only 7% of the children in this series requiring emergency surgery during the neonatal period, a value very close to the 6% reported in the multicentre study by Ruchonnet-Metrailler et al.2 Second, postnatal disappearance of the CPM occurs …

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