Perinatal characteristics and early childhood follow up after ex‐utero intrapartum treatment for head and neck teratomas by prenatal diagnosis

Abstract

Background: Ex utero intrapartum treatment (EXIT) is utilized for safe delivery when a baby has a compromised airway. The purpose of this retrospective study was to examine the indications and outcomes of 11 children presenting with airway occluding oropharyngeal and cervical teratomas. Methods: Study of all children with an airway occluding teratoma delivered via EXIT (2001-2018) in our unit. Primary outcomes included survival and tracheostomy at discharge. Data are reported using descriptive statistics as median (range) and rate (%). Results: We performed 45 EXIT procedure performed between January 2001 and April 2018. Of these, eleven were for cervical and/or upper airway teratoma. Ten (91%) cases had associated polyhydramnios, two (18%) developed nonimmune hydrops, and eight (72%) delivered preterm. Six (45.5%) were performed as an emergency. Estimated blood loss was 1000 ml (500, 1000). The neonatal mortality rate was 18% (2/11) and 33% (3/9) of the survivors were discharged with a tracheostomy. Conclusion: EXIT is a reasonable option for delivery of babies with an occlusive upper airway mass. Neonatal survival depends on individualized factors but may be as high as 82% in those with teratoma.

Prenatal Diagnosis of Oral Teratoma by Ultrasound

“…For teratomas found prenatally in the head or neck, high perinatal mortality usually occurs, mainly as the result of upper airway obstruction due to local mass effect. [ 13 14 ] The size of oral teratomas is an important prognostic factor because larger tumors often cause both feeding difficulties and mechanical airway obstruction. For those identified in the second or third trimester, repeated sonographic evaluations should be undertaken, focusing on the growth of the mass and assessing fetal breathing and swallowing.…”

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

“…The EXIT procedure is widely recognized as a complex and meticulously planned intervention [5,10]. Central to its success is the assembly of a multidisciplinary team with diverse expertise in the realm of fetal intervention [3,25,26]. This collective effort brings together professionals from various specialties, including anesthesiologists, pediatric surgeons, neonatologists, maternal-fetal medicine specialists, and operating room nurses [27].…”

Ex-Utero Intrapartum Treatment-to-Airway for Obstructing Fetal Neck Masses: A Singular Methodology for Monochorionic and Dichorionic Twin Pregnancies

“…Congenital neck masses can obstruct the fetal airway during development, compromising the ability of the newborn to breathe at birth which carries a high risk for hypoxic brain injury and death 1,2 . The Ex Utero Intrapartum Treatment (EXIT) procedure was developed to prevent catastrophic airway obstruction occurring at the time of birth, and has been successfully applied to the treatment of congenital neck masses [3][4][5][6] . In contrast with a normal cesarean delivery, an EXIT procedure requires general anesthesia and the administration of tocolytic medications to maintain uterine relaxation and stable uteroplacental circulation 7 .…”

“… 1 2 The ex-utero intrapartum treatment (EXIT) procedure was developed to prevent catastrophic airway obstruction occurring at the time of birth and has been successfully applied to the treatment of congenital neck masses. 3 4 5 6 In contrast with a normal cesarean delivery, an EXIT procedure requires general anesthesia and the administration of tocolytic medications to maintain uterine relaxation and stable uteroplacental circulation. 7 Stable gas exchange through the umbilical circulation provides time to secure the airway before delivering the baby.…”