Association of Maximum CPAM Volume Ratio in Postnatal Surgical Outcomes in Congenital Lung Malformations

Introduction: Congenital lung malformations (CLMs) range from asymptomatic to those causing significant neonatal morbidity. The maximum CPAM volume ratio (mCVR) is an established prenatal risk stratification tool, but its postnatal predictive value remains less defined. This study aimed to evaluate the relationship between mCVR and postnatal clinical outcomes. Methods: We conducted a retrospective cohort study of neonates with prenatally diagnosed CLM who underwent resection at two fetal centers (2013–2023). Patients were stratified into three groups based on mCVR: <1, 1–2, and >2. Descriptive statistics, Kruskal-Wallis, and Chi-squared tests compared demographic, clinical, and outcome variables across groups. Results: Among 129 neonates with reported mCVR who underwent postnatal resection, median mCVR was 0.8. Neonates with mCVR >2 were significantly more likely to require in-center delivery (95.4% vs. 84.3% vs. 48%, p<0.001), present with symptoms at birth (86.3% vs. 28.1% vs. 20%, p<0.001), and require NICU admission (68% vs. 31% vs. 17%, p<0.001). They also underwent earlier surgery, had longer hospital stays, more thoracotomies, and higher complication rates (all p<0.001). Conclusion: mCVR >2 is a meaningful predictor of neonatal morbidity and can serve as a valuable tool for prenatal counseling and delivery planning.