The research team, led by pediatric surgeons Madeline Adams, Stephanie D. Chao, and Marisa E. Schwab, turned to the MarketScan Commercial Database, a large insurance claims repository that captures detailed billing records from privately insured patients across all fifty states. Using the International Classification of Diseases, Tenth Revision diagnostic codes assigned to congenital lung malformations between 2017 and 2023, the investigators identified affected patients and then required confirmation through cross-sectional chest imaging billed under the corresponding Current Procedural Terminology codes. This two-step approach, pairing a diagnostic code with objective imaging evidence, was designed to filter out coding noise and ensure that the cases counted in the analysis represented genuinely identified malformations rather than administrative artifacts.

The headline number that emerged from the analysis was a prevalence of 2.15 cases per 10,000 patients, which translates roughly into one diagnosed congenital lung malformation for every 4,650 infants in the commercially insured population. That figure may sound modest, but in a nation with roughly 3.6 million annual births it implies thousands of new diagnoses each year, making congenital lung malformations an important index condition for pediatric surgical services. The study also traced how detection changed over the study window: prevalence climbed from 1.80 per 10,000 in 2017 to a peak of 2.67 per 10,000 in 2020 before settling back in subsequent years. Intriguingly, when the researchers built a multivariate model adjusting for other factors, the year of birth itself was no longer a statistically significant predictor of diagnosis, suggesting that the apparent rise and fall may reflect shifting screening practices, coding conventions, or the disruptions of the COVID-19 pandemic era rather than a true change in the underlying biology.

One of the most striking findings in the adjusted model concerned geography. Infants living in the Southern United States were significantly less likely to be diagnosed with a congenital lung malformation than infants elsewhere in the country, with an adjusted prevalence ratio of 0.72 and a 95 percent confidence interval of 0.53 to 0.97, a difference the authors reported as statistically significant at p equals 0.03. In practical terms, this means that after accounting for other variables, babies in the South were diagnosed at roughly 28 percent lower rates than their counterparts in other regions. The study did not identify the mechanism behind this disparity, but the possibilities are consequential: differences in prenatal screening uptake, access to high-resolution fetal ultrasound and fetal magnetic resonance imaging, referral patterns to pediatric surgical centers, or variation in insurance coverage and healthcare-seeking behavior could all contribute. Whatever the cause, the authors note that such regional variation carries clear equity implications for which infants get identified and treated early.

Congenital lung malformations encompass several distinct entities, the most commonly discussed being congenital pulmonary airway malformation, formerly known as congenital cystic adenomatoid malformation, along with bronchogenic cysts, pulmonary sequestration, and hybrid lesions that combine features of more than one type. These malformations arise from errors in early embryonic lung development, when the branching airway tree is forming, and they can range from tiny, asymptomatic lesions discovered incidentally to large masses that compress surrounding lung tissue, shift the mediastinum, and cause respiratory distress in newborns. Many are now caught before birth, because routine second-trimester prenatal ultrasound frequently visualizes echogenic or cystic lung lesions, and specialized centers follow suspicious findings with fetal MRI and serial ultrasound measurements. Specialists sometimes calculate a CPAM volume ratio, a measurement that compares the size of the lesion to the fetal head circumference, to stratify the risk of hydrops and guide the intensity of prenatal surveillance.

What happens after diagnosis, however, has been the subject of genuine clinical debate. Some malformations cause trouble immediately, producing breathing difficulty, recurrent infections, or air trapping that demands prompt surgical resection. Others remain silent for years, and for those lesions the question of whether to operate prophylactically, to prevent future infection or, more controversially, to address a small reported risk of malignant transformation, versus pursuing watchful waiting with serial imaging, remains unsettled in the literature. The new study provides a valuable dose of national data on what actually happens in practice: among infants diagnosed with a congenital lung malformation, 47.72 percent underwent surgical resection. In other words, just under half of diagnosed infants had their lesion removed, while the other half were apparently managed without an operation during the observation window, a split that mirrors the ongoing tension between operative and nonoperative management strategies.

Timing of surgery emerged as another clear pattern. Of the infants who did undergo resection, 96.18 percent had their operation during the first year of life, underscoring that when American pediatric surgeons decide to operate on these lesions, they overwhelmingly do so early rather than deferring intervention into later childhood. This preference for early resection reflects several practical considerations: lesions are often easier to remove before they have caused repeated infections or scarring, compensatory lung growth in infancy may be more robust after lobectomy, and families and clinicians alike often prefer to resolve uncertainty while the child is young. Yet the study also detected a trend over the study period toward decreasing resection rates, hinting that the pendulum may be swinging, at least modestly, toward more conservative management as clinicians gain confidence in surveillance protocols for asymptomatic lesions and as shared decision-making with families becomes more common.

Perhaps the most unexpected finding concerned where the operations took place. Among infants who underwent resection, 21.21 percent received their surgical care in a state different from their home state, meaning that more than one in five families crossed state lines for their child’s lung surgery. This migration of care is a powerful signal of how concentrated specialized pediatric surgical expertise has become. Congenital lung resection, whether performed open or thoracoscopically, demands pediatric anesthesiologists, neonatal intensive care capacity, and surgeons with specific thoracic experience, resources that exist at a limited number of children’s hospitals. Families who live far from such centers may travel hundreds of miles, absorbing significant costs and logistical burdens, and the authors point out that this migration may reshape healthcare utilization patterns in ways that policy makers have not fully accounted for. It also raises equity questions, because families with the means, flexible jobs, and insurance networks to travel may access high-volume expert centers while others may not.

The study’s methodology deserves attention from anyone interpreting its numbers. MarketScan captures commercially insured patients, which means the findings may not generalize perfectly to infants covered by Medicaid or the uninsured, populations that skew differently demographically and geographically. Claims data also cannot capture the full clinical picture: the study cannot distinguish reliably among malformation subtypes, cannot measure lesion size or the presence of symptoms, and cannot reveal why any individual family or surgeon chose surgery or surveillance. The prevalence figure of 2.15 per 10,000 is best understood as a diagnosed prevalence within a privately insured population rather than a true birth prevalence of the underlying malformations, since some lesions likely go undetected and some affected pregnancies do not result in live birth. Still, by requiring imaging confirmation and analyzing seven years of national data, the study sets a firmer baseline than the small single-center series that have dominated the literature.

For clinicians, the takeaways are concrete. The declining resection trend suggests that nonoperative management is gaining real-world traction, which should prompt continued development of evidence-based surveillance protocols and longer-term outcome data on children managed without surgery. The regional diagnostic gap in the South is a call to examine prenatal screening access and referral pathways, because a malformation that goes undiagnosed in infancy may still declare itself later with infection or other complications. And the substantial interstate migration for surgery highlights the need for thoughtful regionalization of pediatric thoracic care, paired with support systems that make expert care reachable for families regardless of zip code. As the first contemporary population-based study of its kind in the United States, this analysis does not settle the clinical debates around congenital lung malformations, but it gives the field something it has lacked: a national map of where things stand today, drawn from the real-world experiences of thousands of infants and their families.

Subject of Research: National prevalence and surgical management of congenital lung malformations among US infants

Article Title: A database study of contemporary diagnosis and management among infants with congenital lung malformations in the United States

Article References: Adams, M., Chao, S. D., & Schwab, M. E. (2026). A database study of contemporary diagnosis and management among infants with congenital lung malformations in the United States. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07785-4

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07785-4

Keywords: congenital lung malformations, pediatric surgery, prenatal diagnosis, CPAM, MarketScan database, epidemiology, healthcare disparities, thoracic surgery, infant health, insurance claims data, regionalization of care, BMC Pediatrics

Congenital lung malformations encompass a spectrum of structural abnormalities, including congenital pulmonary airway malformations, in which cyst-like maldeveloped airway tissue replaces normal lung, and pulmonary sequestration, in which a piece of lung tissue lacks a normal connection to the airway and instead receives its blood supply from the systemic circulation. When these lesions occupy the posterior and lateral basal segments of the lower lung lobe, the segments labeled S9 and S10 in the standard anatomical numbering system, surgeons have traditionally faced a choice between removing the entire lobe through a lobectomy or performing a segmentectomy that isolates and removes only the affected segments. Each option carries trade-offs that matter enormously for a growing child.

Lobectomy is technically straightforward and reliably removes the malformation, which is why it has long been the default operation. But a child’s lungs continue to develop throughout childhood, and every gram of healthy parenchyma removed represents tissue that can never contribute to gas exchange. Segmentectomy, by contrast, demands meticulous dissection of the segmental blood vessels, airways, and the invisible planes between adjacent lung segments, but it preserves the superior segment, known as S6, and its vital connection to the remaining basal lung tissue. The team behind the new study, led by surgeons at the Children’s Hospital Affiliated to Shandong University and Jinan Children’s Hospital, set out to determine whether their arch-shaped modification of segmentectomy could make this lung-sparing option safer and more predictable.

The retrospective analysis reviewed the records of 77 children with congenital lung malformations who underwent thoracoscopic surgery between January 2019 and June 2023. The patients were divided into three groups according to the operation they received: 22 children underwent thoracoscopic lobectomy, 33 underwent conventional thoracoscopic S9-10 segmentectomy, and 22 underwent the new “Arch” thoracoscopic S9-10 segmentectomy. The researchers compared perioperative outcomes, postoperative findings, and radiological follow-up across the groups, and they applied the Bonferroni correction to pairwise comparisons, a statistical adjustment designed to reduce the risk of false-positive findings when multiple comparisons are made simultaneously.

The defining feature of the Arch technique lies in how the surgeon shapes the cut across the lung parenchyma. In a conventional segmentectomy, the division of the S9-10 segments can leave a broad, flat raw surface on the remaining lung, and the interface between the resected area and the preserved superior segment can be technically awkward to manage. The Arch approach instead creates an arch-like, curved resection line that follows the natural anatomical boundary between the basal segments and the superior segment. This curved geometry is intended to preserve the connection between S6 and the remaining basal parenchyma more faithfully, maintain the natural contour of the lower lobe, and reduce tension on the staple or suture lines that seal the lung after the diseased tissue is removed.

Every one of the 77 procedures in the study was completed thoracoscopically, meaning the surgeons operated through small incisions using a camera and long instruments rather than opening the chest. There were no conversions to open thoracotomy, no reoperations, no severe complications, and no residual lesion left behind in any patient. That clean safety record across all three surgical approaches is itself a notable finding, because segmentectomy in children is widely regarded as more technically demanding than lobectomy, and the study demonstrates that in experienced hands both conventional and arch-shaped segmentectomy can be completed entirely through keyhole surgery.

When the researchers examined the details of recovery, some expected patterns emerged. Lobectomy was associated with shorter operative time, shorter chest tube duration, and a shorter postoperative hospital stay than either of the segmentectomy procedures, which is consistent with the simpler nature of removing an entire lobe at once rather than dissecting individual segments. Comparing the two segmentectomy techniques directly, the Arch group showed lower mean blood loss than the conventional group, although the authors were careful to note that the absolute difference was small. The difference in operative time between the two segmentectomy groups did not remain statistically significant after adjustment for multiple comparisons, a reminder that apparent advantages seen in raw numbers can dissolve under rigorous statistical scrutiny.

Complications in the series were few and mild. Postoperative air leak, a common and usually self-limiting event in lung surgery in which air escapes from the cut lung surface into the chest drain, occurred in exactly one patient in each of the two segmentectomy groups, and both leaks resolved with drainage alone. In the Arch group, two patients developed a loculated postoperative air collection, meaning a pocket of air became walled off within the chest cavity, but these collections resolved spontaneously within three months without any surgical intervention. No major complications were observed in the Arch group, and the overall perioperative event profile was similar across all three groups in this series.

The authors are explicit that the study’s conclusions must be interpreted with appropriate caution. As a retrospective review, the analysis depends on how patients were selected for each operation in the first place, and the groups were not randomized. The small differences in perioperative outcomes between the techniques should not be overread, particularly given the statistical adjustments and the modest size of the cohorts. What the study does establish, according to its authors, is feasibility: in selected children whose congenital lung malformations are confined to the S9-10 segments, the Arch thoracoscopic segmentectomy can be performed safely, with no major complications observed, and its main potential value lies in preserving the S6-basal segment connection and normal lung parenchyma that a lobectomy would sacrifice.

That preservation may prove to be the technique’s most important legacy. For a child with decades of growth and physical activity ahead, the difference between losing an entire lower lobe and losing only its two most diseased basal segments could translate into meaningfully better lung function, exercise capacity, and quality of life over a lifetime. The research team emphasizes that prospective studies with long-term functional assessment are needed before the Arch technique can be considered a standard of care, and such studies would need to measure not just operative metrics but actual lung growth and function over years of follow-up. Until then, the study stands as an encouraging proof of concept that the geometry of a surgical resection line, shaped like an arch to respect the lung’s natural architecture, may help surgeons remove disease while giving healthy tissue every chance to thrive.

Subject of Research: Arch-shaped thoracoscopic segmentectomy for congenital lung malformations in children

Article Title: Arch-like thoracoscopic posterior and lateral basal segmentectomy for congenital lung malformations in children

Article References: Guo, R., Zhang, S., Zhai, Y., Zhao, H., Cui, R., & Li, J. (2026). Arch-like thoracoscopic posterior and lateral basal segmentectomy for congenital lung malformations in children. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07655-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07655-z

Keywords: congenital lung malformations, thoracoscopy, segmentectomy, pediatric surgery, minimally invasive surgery, lung-preserving surgery, lobectomy, S9-10 segments, pulmonary sequestration, CPAM, thoracic surgery, BMC Pediatrics