In a large, symptomatic bronchopulmonary sequestration in the neonate, which treatment may be necessary?

• A. Observation alone
• B. Emergent surgical repair
• C. Medical therapy with bronchodilators
• D. Prolonged mechanical ventilation only

Answer: (B)

In a neonate with a large, symptomatic bronchopulmonary sequestration, the main issue is a nonfunctional piece of lung that has its own systemic blood supply and can cause ongoing respiratory distress, infection, and potential cardiovascular strain. The best approach is emergent surgical repair to remove the sequestration and ligate its abnormal feeding artery. This definitive treatment eliminates the nonfunctional tissue and the problematic blood supply, resolves the cause of symptoms, and reduces risk of future complications.

Observation would leave the lesion untreated and at risk for worsening symptoms. Bronchodilators address airway smooth muscle but not the sequestered tissue or its abnormal circulation. Prolonged mechanical ventilation provides support but does not cure the underlying anomaly.