Ex utero intrapartum treatment for extremely low birth-weight neonates requiring resuscitation at birth

Hung, Tai-Ho; Huang, Ting-Xuan; Hsieh, T’sang‐T’ang

doi:10.1016/j.tjog.2017.07.001

Cited by 3 publications

(11 citation statements)

References 10 publications

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“…The 18 studies were published in journal issues between 2014 and 2023. However, some papers appeared online before their formal publication date, and that is how we included them in our review up to 14 November 2022 12–14,19–33 . We searched for all papers published since the inception of the databases we used, but the two earliest articles identified in this scoping review were published in 2014.…”

Section: Resultsmentioning

confidence: 99%

“…We found that 164 neonates in five studies were stabilised or resuscitated on commercially available Lifestart trolleys (Inspiration Healthcare), 19,21,24,27,33 while 134 neonates in seven studies were placed on bedding, such as mattresses, drapes or towels 13,14,20,22,26,30,31 . Five papers reported that they used locally developed and assembled trolleys for a total of 88 neonates 23,25,28,29,32 . The commercial Concord trolley (Concord Neonatal B.V.) was used for nine neonates in one study 12 (Table 2).…”

Section: Resultsmentioning

confidence: 99%

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Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review

Alikhani,

Thies‐Lagergren,

Svedenkrans

et al. 2023

Acta Paediatrica

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AimThis scoping review identified studies on approaches to intact cord resuscitation and/or stabilisation (ICR/S) for neonates delivered by Caesarean section (C‐section).MethodsA systematic literature search was carried out using the PubMed, Web of Science, Scopus, Cochrane and CINAHL databases to identify papers published in English from inception to 14 November 2022.ResultsWe assessed 2613 studies and included 18 from 10 countries, covering 1–125 C‐sections: the United States, the United Kingdom, Australia, India, Italy, China, France, The Netherlands, New Zealand and Taiwan. The papers were published from 2014 to 2023, and the majority were randomised controlled trials and observational studies. Different platforms, equipment and staff positions in relation to the operating table were described. Options for resuscitation and stabilisation included different bedding and trolley approaches, and maintaining aseptic conditions was mainly addressed by the neonatal team scrubbing in. Hypothermia was prevented by using warm surfaces, polythene bags and radiant heaters. Equipment was kept easily accessible by mounting it on a trolley or a separate mobile pole.ConclusionWe could not reach definitive conclusions on the optimal method for performing ICR/S during a C‐section, due to study variations. However, a number of equipment and management options appeared to be feasible approaches.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review

Alikhani,

Thies‐Lagergren,

Svedenkrans

et al. 2023

Acta Paediatrica

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“…Subramanian et al 12 cites one case in which the procedure had to be abandoned due to haemorrhage despite the use of harmonic scalpel; however, this was not an outcome in any of the cases reviewed. Hung et al 16 describes the placement of transarterial balloons bilaterally in the patient's internal iliac arteries as a preventative measure for postpartum haemorrhage. This is not described in any other cases and was not required to be used; therefore, may be an unnecessary invasive procedure.…”

Section: The Proceduresmentioning

confidence: 99%

“…Hung et al 16 explain that neonates with extremely low birth weight are very difficult to intubate and quickly deteriorate when attempts fail. They described EXIT procedures in two patients, one with a single fetus and one with twins, who were likely to have preterm labour.…”

Section: Extremely Low Birth Weightmentioning

confidence: 99%

“…All three patients underwent what appear to be modified EXIT procedures, as the authors refer to delayed cord clamping as their strategy and the fetuses were all fully delivered onto a working area above the mother's legs for easy intubation. Hung et al 16 identify this method as having risks such as hypothermia, shorter umbilical cord in ELBW fetus, logistical issues with the working area and potential for dislodging the endotracheal tube on transfer.…”

Section: Extremely Low Birth Weightmentioning

confidence: 99%

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Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Silva¹

2019

Journal of Perioperative Nursing

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Problem identificationEx Utero Intrapartum Treatment (EXIT) has become the optimal delivery strategy in fetuses with airway compromise; however, it remains an extremely rare procedure. This review aims to provide perioperative nurses with an overview of EXIT procedure to enable them to be an effective member of the multidisciplinary team. Literature searchAn electronic search of the CINAHL, Medline and Scopus databases was undertaken yielding 19 articles for inclusion in this integrative review. The papers included were case studies, case series or retrospectives and describe 42 EXIT procedures with 43 babies. Data evaluation synthesisThe most common indication for the EXIT procedure is neck tumours, with other indications being congenital high airway obstruction syndrome (CHAOS), cardiac anomalies, extremely low birth weight (ELBW), micrognathia and congenital diaphragmatic hernia. Literature revealed 41 cases had successful establishment of an airway, with the procedure failing in two cases, both with diagnoses of CHAOS. Implications for perioperative nursing practice or researchThe role of the perioperative nurse within these cases needs to be explored further. Perioperative nurses need to have the skills and ability to participate as key members of the multidisciplinary team. This can be achieved through in-depth understanding of the topics within this review.

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Cesarean section with operation on placental support as an adapted EXIT procedure for fetal thyroid goiter: A case report and literature review

Diawtipsukon,

Moradokkasem,

Chansriniyom

et al. 2024

Intl J Gynecology & Obste

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The ex‐utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero–placental–fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource‐limited settings.

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Ex utero intrapartum treatment for extremely low birth-weight neonates requiring resuscitation at birth

Abstract: When cesarean delivery is indicated in ELBW infants and intubation after birth is anticipated, DCC after establishing a secured airway may help maintain neonatal cardiovascular stability and allow physicians to resolve the technical difficulties of intubation.

Cited by 3 publications

References 10 publications

Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review

Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review

Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Cesarean section with operation on placental support as an adapted EXIT procedure for fetal thyroid goiter: A case report and literature review

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