B.B. Jeon1,2, S.M. Larabee2, A. Mina1,2, D. Alonso1,2, S.E. Peiffer1,2, T.C. Lee1,2, S.G. Keswani1,2, A. King1,2 1Baylor College of Medicine, Michael E. DeBakey Department Of Surgery, Houston, TEXAS, USA 2Texas Children’s Hospital, Department Of Surgery, Division Of Pediatric Surgery, Houston, TX, USA
Introduction: Fetal pleural effusions(FPE) are rare with limited data available to support approaches to management. In this study, we evaluated the diagnosis and management of fetal patients diagnosed with pleural effusions. The aim was to describe clinical outcomes to further the understanding of the natural history of this condition.?
Methods: This was a retrospective study of 62 pregnancies diagnosed with FPE between January 2018 and July 2023 at a tertiary children’s hospital. Demographic and clinical data, pre- and postnatal imaging, fetal interventions, delivery information, and clinical outcomes were collected and descriptively analyzed.
Results: We identified 62 patients with a prenatal imaging diagnosis of fetal pleural effusion. 2 (3.2%) patients were lost to follow-up. Of the remaining 60 patients, 32 (53%) patients received fetal interventions to manage the FPE. Of 32 patients who received surgical intervention, 28 (88%) had hydrops. Of 28 non-surgical patients, hydrops were noted in 9 (32%). 24 (24/60, 40%) patients had thoracoamniotic shunts (TAS) placed: 10(17%) patients received 1 shunt, 9 (15%) patients received 2 shunts, 4 (6.7%) patients received 3 shunts, and 1 (1.6%) patient had 4 shunts placed. The first shunt was placed at a median gestational age of 26.7 weeks with [IQR 24-29.4]. The etiology was determined to be chromosomal or genetic in 16 (27%) cases, including trisomy 21(8, 13.3%) and Turner syndrome (5, 8.3%). 7 (12%) cases were attributed to congenital diaphragmatic hernia, however, a majority (33, 55%) were unknown. Overall, there were 2 (3.2%) terminations and 8 (13%) Intrauterine fetal deaths (IUFDs). Postnatally, 14 neonates (14/32, 44%) who received fetal intervention died while 3 patients (3/28, 11%) without fetal intervention died. Overall, the majority of patients (35/60, 58%) were inborn with 28 (80%) newborns admitted to the NICU with a median NICU stay of 12 days [IQR 2-64]. 14 (40%) required postnatal chest tubes and 22 (63%) required intubation. The inborn had a median gestational age of 35.3 weeks [IQR 32.8-38.3] and a median birthweight of 2.9 kg [IQR 2.4-3.5]. A total of 12 (34%) newborns died, with the majority (10/12) of deaths before 30 days including 3 deaths within 24 hours of birth.
Conclusion: Many patients with FPE will undergo fetal surgical intervention with multiple TAS placed. There is a high mortality rate for newborns diagnosed with FPE with a high rate of postnatal interventions including the need for intubation and placement of chest tubes.