Services

While many babies with a fetal lung lesion will not require treatment during pregnancy and delivery, 10-15% of babies develop complications that require intervention after birth.

At Texas Children’s, we are experienced in caring for the full spectrum of patient needs. Our services include the following:

Prenatal management and monitoring

Mother and baby will be closely monitored throughout pregnancy with regular ultrasounds to assess the growth of the lesion and the risks to the fetus, to guide treatment decisions. Because there is potential for the CPAM to grow dramatically, we monitor your pregnancy very closely with ultrasound. With every ultrasound, we calculate a CVR (CPAM-volume-ratio) where we look at the relative size of the lesion to your baby. We use the CVR in an algorithm based-on our high volume center’s data to help monitor the lesions growth and gauge the risk to your baby. We tailor how often we follow your baby’s lung lesion to your child, based on size and how they are being affected by the mass. Sometimes, lung lesions will continue to shrink on prenatal ultrasounds. These babies usually do very well throughout their pregnancy and can go home after delivery with follow-up with our pediatric surgeons 2 months after delivery.

Medical treatment

If the mass is large and growing too quickly, the mother may be given two steroid injections to slow the growth of the fetal lung lesion and help alleviate any signs of hydrops, a condition in which fluid accumulates in the baby’s body, a possible sign of fetal heart failure.

Fetal intervention

If the baby shows signs of developing complications from the lesion, fetal therapy may be recommended. Fetal treatment options include:

• Draining the lesion - large, fluid-filled lesions may be treated with drainage procedures (thoracentesis) where a thin needle is placed through mom's uterus to drain the fluid. We may offer to place a shunt, (a straw-like tube), which drains the fluid from the fetus’s chest into the uterus.
• Open fetal surgery - to remove the lung mass (lobectomy), in life-threatening cases. A few patients with large and solid lesions may need surgery during the pregnancy to remove the lesion.  This treatment is reserved for fetuses that have very large lesions that cannot be drained and, despite medical treatment, continue to compress the heart with high risk for heart failure. Texas Children’s Fetal Center is one of the few in the world to have successfully performed this procedure for a life-threatening case of CPAM.

EXIT-to-resection procedure

If your baby’s lung lesion is very large and stays large until the time of delivery, it can cause breathing difficulties at birth. Our team may recommend a special birth plan that involves fetal surgery during delivery, known as an EXIT (ex-utero intrapartum treatment)-to-resection procedure, to ensure the child isn’t deprived of oxygen at birth. This plan involves caesarian section-like delivery of your baby and resection of the lung lesion while the baby is still connected to mom and supported by the placenta.

Early delivery for treatment of maternal mirror syndrome

In rare cases, if the fetus shows signs of complications such as fetal hydrops, the mother may develop a syndrome in which her condition mirrors the fetus, with pre-eclampsia and swelling that endanger her health and require early delivery.

Delivery at Texas Children’s Pavilion for Women

We offer the expertise, resources and coordinated approach required for the delivery and postnatal care of babies with moderate to severe fetal lung lesions, including the highest level of neonatal intensive care (NICU), if needed.

Most patients can proceed with vaginal delivery, unless there are obstetric reasons to have a caesarian delivery. They should follow up with our TCH Congenital Lung Lesion Program pediatric surgeons at two months after delivery.

For patients with moderate to severe CPAMs, we recommend delivery at a tertiary facility, such as Texas Children’s Pavilion for Women. For families who live in the area, or would like to deliver locally, our facility allows for care of the mother and baby in one comprehensive unit. 

Treatment after birth

Treatment for lung lesions typically involves surgery after birth to remove the mass, preventing the development of infection or possible cancer later in life. Timing of the surgery depends on the health of your baby at birth.

If your newborn experiences breathing difficulties or a prolonged need for oxygen after delivery, surgery to remove the mass may be recommended before going home.

Babies with no problems at birth typically go home with the mother. A follow-up appointment with our pediatric surgeon at two months of age is recommended to discuss management and removal of the lesion. Surgery is generally performed between two and six months of age to take advantage of the growth potential of the remainder of the lungs.

Once your baby is born, they are carefully monitored for problems that may be caused by their CPAM. Complications may including breathing issues or the prolonged need for oxygen. If your baby shows signs of having any problems because of the lung lesion, we recommend removal of the lesion before going home.

Many babies with smaller lesions will have no problems once they are born. These babies may room-in with mom and be discharged home. We recommend these babies have close follow up with our pediatric surgeon (2 months after delivery) to discuss the management of these lesions.  Some lesions may be at risk of getting infected (pneumonia) and a few of them are difficult to distinguish from lesions that may be cancerous. 

A consultation with our pediatric surgeon is important to help discuss the management options. For those needing surgical removal we typically recommend removal of the lesion at 2-6 months to take advantage of the growth potential of the remainder of the lungs. 

Minimally Invasive (Thoracoscopic) Surgery

Texas Children’s has one of the highest volumes of minimally invasive lobectomies for congenital lung lesions in the nation. During the procedure, a tiny thoracoscopic camera with very small incisions are used to remove the lung lesion. We typically leave a chest tube to help drain fluid and keep the normal lung expanded.

If surgery is required on a newborn, some babies may require a breathing tube afterwards, as well as IV nutrition and antibiotics. Your baby is ready to go home once the chest tube has been removed and they are doing well and breathing normally.

Texas Children’s Pediatric Surgery Department has one of the greatest volumes of minimally invasive lobectomies for congenital lung lesions. We use a thoracoscopic camera to remove these lung lesions. We typically leave a chest tube to help drain fluid and keep the normal lung expanded. If the surgery is performed as a neonate, some babies may require a breathing tube afterwards, as well as IV nutrition and antibiotics. Your baby is ready to go home once they are doing well with removal of the chest tube and breathing normally.  At TCH, we continue to follow your child from in utero to adulthood in our long term outcomes clinic to optimize their pulmonary health and neurodevelopmental outcomes. 

Family-centered classes

Texas Children’s offers small, family-centered classes that many families find helpful when preparing for their newborn’s hospitalization.

Follow-up care

Our specialists follow your child from in utero to adulthood through our long-term Congenital Lung Lesions Outcomes Clinic, where are pediatric surgeons and pulmonologist will follow you throughout development to help optimize pulmonary health and neurodevelopmental outcomes.