Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally

Abstract

Introduction: Advances in fetal imaging have allowed us to identify abnormalities previously not appreciated. With this study, we hope to identify factors predicting a difficult airway at birth and review the perinatal outcomes of these patients. Methods: Sixteen patients with antenatally diagnosed micrognathia were reviewed from a tertiary care hospital database from 2011 to 2016. Jaw index (JI), amniotic fluid index (AFI), glossoptosis, gastric size, and oropharynx obliteration were assessed. The airway support required at birth, specialist team involvement, and outcomes were evaluated. Results: Nine (56.3%) of 16 patients had JI <5th percentile, 3 (33.3%) of 9 had difficult intubation, 2 (22.2%) of 9 needed an emergency tracheostomy, and 1 (11.1%) of 9 died. Seven patients had polyhydramnios, 2 (28.6%) of 7 had difficult intubation, 2 (28.6%) of 7 required tracheostomy, and 1 (14.3%) of 7 died. Twelve patients had either JI <5th percentile or abnormal AFI, 5 (41.7%) of 12 had difficult intubation, 2 (16.7%) of 12 required tracheostomy, and 1 (8.33%) of 12 died. For the group without otolaryngology consultation, 8 (50%) of 16, 1 (12.5%) of 8 had difficult intubation and 1 (12.5%) of 8 died because airway was not secured after 45 minutes of resuscitation. Conclusion: Jaw index <5th percentile or abnormal AFI predicts a difficult airway. A multidisciplinary approach with otolaryngology involvement for airway intervention may be required at birth.

Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures

“…Compared with neck masses, micrognathia is a more recent indication for EXIT. 29,30 To date, most outcome data for micrognathia in EXIT procedures is gathered from case reports 18,[30][31][32][33][34][35][36] or small case series. 37 The diagnosis of micrognathia on antenatal ultrasound has traditionally been subjective.…”

“…There are no validated prenatal criteria to determine which cases of fetal micrognathia are suitable for EXIT. Several authors have proposed measuring inferior facial angle (IFA), jaw index, frontal nasomental angle, mandible width/maxilla width ratio and mandibular angle, glossoptosis, gastric size, and oropharynx obliteration 13–18 …”

“…Several authors have proposed measuring inferior facial angle (IFA), jaw index, frontal nasomental angle, mandible width/maxilla width ratio and mandibular angle, glossoptosis, gastric size, and oropharynx obliteration. [13][14][15][16][17][18] We present a 23-year experience of EXIT procedures in a tertiary center, with a description of changing indications, predictors of severe airway obstruction, and long-term survival indicators in this cohort.…”

Neonatal outcomes of foetal micrognathia: An 11‐year review

“…Despite advances in foetal imaging with ultrasonography, magnetic resonance imaging (MRI) and 3D reconstruction, predicting potentially life‐threatening neonatal difficult airways remains a major challenge for obstetricians and neonatologists. Among predictive factors, amniotic fluid index (AFI) > 97 th centile and/or MRI jaw index <5 th centile have been associated with a difficult airway at birth, the need for a tracheostomy or death 7 …”

“…7 Antenatal multidisciplinary team (MDT) discussions, involving experienced obstetricians, geneticists, ear, nose and throat (ENT) surgeons, paediatric anaesthetists and neonatologists, are often required to optimise the place of delivery and management at birth. 7 Additionally, severe micrognathia is an indication for an ex utero intrapartum treatment (EXIT) procedure performed only in expert centres and requires complex planning by an experienced MDT. 7 To help guide our management planning, we conducted a singlecentre retrospective observational study over an 11-year period to identify any distinguishable features on antenatal scans in foetuses with antenatally diagnosed micrognathia that can help anticipate a difficult airway at birth and/or poor neonatal outcome.…”