Congenital Pulmonary Airway Malformations: Experience of a Tunisian Tertiary Referral Center Over a Five-Year Period.

Background: Congenital pulmonary airway malformations (CPAMs) are rare developmental lung anomalies. The optimal management of asymptomatic neonates remains a subject of debate. This study presents the experience of a Tunisian tertiary referral in the prenatal and postnatal diagnosis and management of CPAM.

Methods: We conducted a 5-year retrospective descriptive study (2019-2024) study in the Neonatology and Intensive Care Unit of the Maternity and Neonatology Center of Tunis. All neonates diagnosed with CPAM were included.

Results: Thirteen neonates with CPAM were managed. The mean maternal age was 31.4 yearsAntenatal diagnosis was made in 77% (10/13) of cases. Polyhydramnios was observed in two cases, hydrops fetalis in one, and dextrocardia in one. No antenatal interventions were performed. Cesarean section was performed in 10 cases, including four for fetal indications. Three neonates developed severe respiratory distress requiring mechanical ventilation; two died before surgical intervention, and one underwent lobectomy via thoracotomy at 9 months via thoracotomy, with an uneventful recovery. Histopathological examination confirmed type II CPAM. The remaining 10 patients were managed conservatively, with favorable outcomes during a mean follow-up of 4 years.

Conclusions: The management of CPAM requires a multidisciplinary team and begins in the antenatal period. Even asymptomatic patients require close and prolonged monitoring, as complications may arise later. Surgical intervention should be considered on a case-by-case basis.