EXIT procedure for fetal neck masses

Olutoye, Oluyinka O.; Olutoye, Olutoyin A.

doi:10.1097/mop.0b013e3283531b51

Cited by 46 publications

(63 citation statements)

References 53 publications

(44 reference statements)

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“…One approach to this problem is the newly described tracheoesophageal displacement index, an objective method that has been proposed to try and predict neonates that require intervention on placental support . The future of this field will benefit from studies correlating outcomes with prenatal imaging characteristics to better indicate when to proceed with EXIT …”

Section: Commentsupporting

confidence: 63%

Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned

et al. 2013

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Section: Commentsupporting

confidence: 63%

Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned

et al. 2013

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“…EXIT is performed under maternal deep general anesthesia with continuous invasive blood pressure monitoring. Details of the procedure have been previously published …”

Section: Methodsmentioning

confidence: 99%

Cervical lymphatic malformations: Prenatal characteristics and ex utero intrapartum treatment

et al. 2019

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Background The ex utero intrapartum treatment (EXIT) is utilized to transition fetuses with prenatally diagnosed airway obstruction to postnatal life. We describe the unique clinical course, diagnosis, treatment, and outcomes of patients with cervical lymphatic malformation (CLM) managed with EXIT. Methods Review of fetuses with diagnosed CLM was delivered by EXIT (2001‐2018) in a tertiary referral fetal center. Outcomes included survival, tracheostomy at discharge, neonatal course after delivery, and pulmonary hypoplasia. Data are reported as median [range] and rate (%). Results Out of 45 patients delivered by EXIT, 10 were delivered for CLM: seven had polyhydramnios, one had nonimmune hydrops, five delivered preterm, and three were emergency EXITs. The EXIT time and estimated blood loss were 125 minutes (95, 158) and 900 mL (500, 1500), respectively. Airway was secured in all. There was one neonatal death (day 8) with prematurity, sepsis, and pulmonary hypoplasia. Three out of nine were discharged with a tracheostomy. Conclusion In CLM, close monitoring for structural neck involvement and development of polyhydramnios are important and may be an indication for EXIT as the optimal delivery mode. An experienced multidisciplinary team is a key factor for an effective approach to the obstructed airway in CLM.

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“…The presence of polyhydramnios and hydrops in these cases can negatively affect prognosis. Long-term follow-up has not been sufficiently reported (3,10). Parents should be informed about the difficulties and outcomes of the EXIT procedure in further detail.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is vital to ensure airway opening. The EXIT procedure should be considered if there is a concern associated with neonatal airway compromise or cardiorespiratory instability (3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, insufficient equipment and unqualified staff may not only cause a poor fetal prognosis but also maternal complications. There are a few studies in the literature regarding which patients should receive the EXIT procedure (3)(4)(5). The aim of this study was to share our experiences on the antenatal and perinatal evaluation methods to determine the need for the EXIT procedure.…”

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confidence: 99%

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Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure

Özgünen¹,

Güleç²,

Evrüke³

et al. 2015

Balkan Med J

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Oropharyngeal and neck tumors are rarely seen in fetal life. The lesions located in the area involve cystic hygroma, teratoma, ranula, epulis, hemangioma, congenital goiter, solid thyroid tumor, thyroid cyst or thyroglossal duct cyst, branchial cleft cyst, neuroblastoma and hamartoma. The most common types are cervical teratoma and cystic hygroma (1). These tumors have the potential to obstruct the airway, which can be life threatening, and endotracheal intubation can be difficult or impossible due to anatomic distortion.The aim of the ex-utero intrapartum therapy (EXIT) procedure is to maintain the newborn's airway open during placental circulation after the partial delivery of a fetus, and, in this way, to protect the fetus from hypoxia until providing an open airway (2). As fetoplacental circulation continues, endotracheal intubation is implemented for opening the airway of the fetus. If this is not possible, other interventions such as bronchoscopy or tracheostomy and excision of the mass can be applied (1-3). However, the EXIT procedure is not a treat- Background:The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. Case Report: Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. Conclusion: The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.

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EXIT procedure for fetal neck masses

Cited by 46 publications

References 53 publications

Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned

Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned

Cervical lymphatic malformations: Prenatal characteristics and ex utero intrapartum treatment

Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure

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