Four cases of congenital airway obstruction: optimising perinatal management

Abstract

Congenital anomalies causing airway obstruction in the newborn are potentially fatal. However if an effective airway can be maintained the long-term prognosis is often excellent. We present four cases of airway obstruction, three of which were diagnosed antenatally. We discuss the role of antenatal imaging and review delivery options including the need for a multidisciplinary team approach. In conclusion, we recommend antenatal imaging with both ultrasound scan and magnetic resonance to inform perinatal management. Polyhydramnios, in association with suspected neonatal airway obstruction, should alert clinicians to a high-risk situation. We recognize that even in skilled hands, securing an airway can be very difficult and alternatives such as maintenance of the fetomaternal circulation or extra-corporeal life support should be considered.

An interventional airway delivery service for congenital high airway obstruction

“…Our experience prior to development of a complex airways interventional delivery team demonstrated that antenatal diagnosis is insufficient to improve survival (Table I; n = 4) 1 . Antenatal discussion between different medical specialists resulted in having the ENT team on ‘standby’ to intervene if intubation failed, and highlighted the need for a detailed airway intervention plan.…”

“…Congenital airway obstruction is rare; prior to improvements in imaging, it may have presented as an emergency late in pregnancy or during labour, requiring emergency intervention at birth. However, improved antenatal diagnosis of congenital airway obstruction alone does not improve outcomes, even when an ENT team is present to assist in securing the airway via intubation or tracheostomy if the neonate does not breathe spontaneously 1 . Outcomes can be improved by performing an interventional delivery and adopting an immediate airway intervention strategy to ensure neonatal oxygenation and secure an airway.…”

A newborn with respiratory distress and hydrocephalus caused by a giant mature teratoma

“…There are many alternatives to the EXIT procedure for airway management, with the best choices related to tumor involvement in the airways, including fiberoptic intubation, conscious intubation, tracheostomy and blind nasal intubation [2]. The gold standard for treatment is complete surgical excision of the neoplasm in addition to chemotherapy in the case of malignant teratomas [1,3,6,7]. Survival after surgery is more than 80%, but since these tumors tend to be large, extensive neck dissection and multiple additional procedures are often necessary to achieve complete resection of the tumor.…”

“…These lesions contain all three germ layers and may be composed of mature or immature elements. In the neonate, the presence of immature elements does not correlate with malignant potential, and most of these teratomas are benign [1,3,6,12,13].…”