Outcomes and Late Complications after Pulmonary Resections in the Pediatric Population Daniel Kreisel, MD, PhD, Alexander S. Krupnick, MD, and Charles B. Huddleston, MD Neonates and children undergo lung resections for a variety of indications. These proce- dures can be performed with low mortality and low morbidity rates in the early postoper- ative period. There exist important anatomic and physiologic differences between the pediatric and the adult population, which thoracic surgeons need to be aware of. On the one hand, the capacity of the lung to grow during the first few years of life is associated with relative preservation of postoperative pulmonary function in children. On the other hand, the relative flexibility of their tissue structures places pediatric patients at increased risk for developing postpneumonectomy syndrome. Moreover, surgeons need to take the child’s growth and development into consideration when planning their operative approach for thoracic procedures. Semin Thorac Cardiovasc Surg 16:215-219 © 2004 Elsevier Inc. All rights reserved. KEYWORDS postnatal lung growth, postoperative pulmonary function, postpneumonectomy syndrome, musculoskeletal development P ulmonary resections in the pediatric population are most commonly performed for a variety of congenital abnor- malities including congenital lobar emphysema, broncho- genic cysts, cystic adenomatoid malformations, and pulmo- nary sequestrations. Less common indications include neoplasms, trauma, and infections as well as diagnostic pro- cedures. The age of children undergoing pulmonary resec- tions has steadily decreased over the last decades reflecting a decline in such procedures performed for infectious etiolo- gies and a rise in resections performed for congenital malfor- mations. 1 Similar to the adult population, resections range from nonanatomic wedge resections to lobectomies and pneumonectomies. Pulmonary resections can be performed in children with low mortality rates. 1,2 However, children differ from adults in a number of fundamental ways, and there are important physiologic aspects unique to the pedi- atric population that can have significant implications after lung resection. This review will focus on late pulmonary ef- fects and complications after pulmonary resections in the pediatric population. Postnatal Lung Growth An understanding of normal lung growth in the postnatal period is essential to predict pulmonary function after lung resection in children. It is well established that alveoli multi- ply after birth. 3 Utilizing morphometric techniques, Dunnill was able to show that the number of alveoli rises from ap- proximately 20  10 6 at birth to approximately 300  10 6 by the age of eight. 4 The most rapid increase in the number of alveoli occurs during the first three years of life. After eight years of age, the number of alveoli remains constant. The lung volume doubles between the ages of 8 and 25, which can be accounted for by the increase in the volume of indi- vidual alveoli. 4 Pulmonary arteries grow in diameter postna- tally and their wall thickness decreases. Animal experiments have documented growth of the remaining lung after pneu- monectomy. Not surprisingly this response appears to be most vigorous in the newborn period. 5 Lung growth has been documented in children with hypoplastic lungs secondary to congenital diaphragmatic hernia, who underwent diaphrag- matic repair as a newborn. 6 Postoperative Pulmonary Function While pulmonary resection in an adult leads to a propor- tional decrease in lung volume, case series evaluating pulmo- nary function after lung resection performed during infancy Division of Cardiothoracic Surgery, Department of Surgery, Washington Uni- versity School of Medicine, St. Louis, MO 63110. Address reprint requests to Charles B. Huddleston, MD, Professor of Sur- gery, Chief, Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110. E-mail: huddlestonc@msnotes.wustl.edu 215 1043-0679/04/$-see front matter © 2004 Elsevier Inc. All rights reserved. doi:10.1053/j.semtcvs.2004.08.002