Prediction of neonatal respiratory distress in pregnancies complicated by fetal lung masses

Objective The objective of this article is to evaluate the utility of fetal lung mass imaging for predicting neonatal respiratory distress. Method Pregnancies with fetal lung masses between 2009 and 2014 at a single center were analyzed. Neonatal respiratory distress was defined as intubation and mechanical ventilation at birth, surgery before discharge, or extracorporeal membrane oxygenation (ECMO). The predictive utility of the initial as well as maximal lung mass volume and congenital pulmonary airway malformation volume ratio by ultrasound (US) and magnetic resonance imaging (MRI) was analyzed. Results Forty‐seven fetal lung mass cases were included; of those, eight (17%) had respiratory distress. The initial US was performed at similar gestational ages in pregnancies with and without respiratory distress (26.4 ± 5.6 vs 22.3 ± 3 weeks, p = 0.09); however, those with respiratory distress had higher congenital volume ratio at that time (1.0 vs 0.3, p = 0.01). The strongest predictors of respiratory distress were maximal volume >24.0 cm3 by MRI (100% sensitivity, 91% specificity, 60% positive predictive value, and 100% negative predictive value) and maximal volume >34.0 cm3 by US (100% sensitivity, 85% specificity, 54% positive predictive value, and 100% negative predictive value). Conclusion Ultrasound and MRI parameters can predict neonatal respiratory distress, even when obtained before 24 weeks. Third trimester parameters demonstrated the best positive predictive value. © 2017 John Wiley & Sons, Ltd. What's already known about this topic? Neonates with congenital lung masses may experience respiratory distress. US and MRI performed in the third trimester can predict neonatal respiratory distress. What does this study add? US and MRI parameters including CVR and lesion volume obtained before 24 weeks' gestation can predict neonatal respiratory distress. Maximal lesion volume >34 cm3 by US and maximal lesion volume >24 cm3 by MRI had the best positive predictive value for neonatal respiratory distress.