Ex Utero Intrapartum Treatment of Fetal Micrognathia

DaValle, Brandon; Nagel, Erik; Gonzalez, Sara C.; Gaconnet, Cory; Latendresse, Thomas; You, Whitney; Johnson, Christopher; Brigger, Matthew T.

doi:10.7205/milmed-d-13-00466

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Micrognathia by definition refers to an abnormally small mandible, while retrognathia refers to an abnormally positioned mandible. 9 These 2 findings often coexist and can present as a spectrum of severity. They can occur in isolation or as part of a sequence such as Pierre Robin sequence or syndromes such as Cornelia de Lange, Stickler, or Treacher-Collins.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

“…7,8 To date, most of the studies were case reports or small case series with few patients. [9][10][11] With this study, we hope to identify factors that predict a difficult airway at birth and review the perinatal outcomes of patients with antenatally diagnosed micrognathia on fetal imaging.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally

et al. 2019

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“…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.…”

Section: Degree Of Micrognathiamentioning

confidence: 99%

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

Porter

Trivedi

Márquez³

et al. 2022

Prenatal Diagnosis

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Objective: In cases of suspected neonatal airway obstruction, the ex-utero intrapartum treatment (EXIT) procedure is used to secure the airway while a fetus remains on placental circulation. We report indications and outcomes from all EXIT procedures at a tertiary obstetric unit between 1997 and 2020.Method: Retrospective cohort study with data collected from maternal and neonatal medical records.Results: Indications for EXIT procedures were micrognathia (n = 7), lymphatic malformations (n = 5), cervical teratomas (n = 4), goiters (n = 2), and intra-oral epulis (n = 1). Infants with a fetal teratoma were delivered earliest due to 75% presenting with preterm premature rupture of membranes or preterm labor. Low birth weight was found in 75% of these neonates; they did not survive 1 year.Intubation at EXIT occurred for 58% (n = 11) of babies, and six neonates required a tracheostomy. In four cases of fetal micrognathia, the inferior facial angle (IFA) was noted to be <5th centile. All but one micrognathia case had polyhydramnios. Of the total cohort, 75% of neonates were alive at 1 year. Conclusion:Risks for neonatal demise with EXIT include fetal teratoma, low birth weight, and prematurity. Micrognathia has become an increasingly valid indication for the procedure. The combination of polyhydramnios and IFA <5% correlates well with severe airway obstruction and suggests consideration of EXIT. Key points What's already known about this topic?� Ex-utero Intrapartum Treatment (EXIT) remains a potentially life-saving procedure for fetuses with airway obstruction. Indications for EXIT have broadened over the past 20 years. What does the study add?� Fetal teratoma, low birth weight, and prematurity should inform prenatal counseling as predictors for fetal and neonatal mortality.� To improve multidisciplinary management, all neonates with suspected fetal airway obstruction should have ultrasound and MRI imaging.� Micrognathia is now a common indication for EXIT. In cases of micrognathia, inferior facial angle (IFA) <5% in conjunction with polyhydramnios appears predictive of a difficult airway.

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Value of Imaging Measurements in Micrognathia‐Related Fetal Airway Obstruction Within a Fetal Center

Eyring,

Allen,

Bayazid

et al. 2024

The Laryngoscope

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ObjectiveFetal imaging often identifies signs of upper airway obstruction due to micrognathia that may require airway intervention at delivery. This study investigated the role of quantitative fetal imaging measurements in predicting the need for otolaryngology consultation and intervention within a multidisciplinary Fetal Center.MethodsData were retrospectively collected from expectant mothers attending a multidisciplinary Fetal Center from January 2017 to October 2023. Cases of fetal micrognathia associated with potential upper airway obstruction were analyzed, focusing on prenatal ultrasound and magnetic resonance imaging (MRI) findings, genetic testing results, and interventions at birth.ResultsAmong 25 pregnancies identified, diverse prenatal diagnoses were observed. Post hoc quantitative fetal ultrasound/MRI measurements included inferior facial angle, anteroposterior diameter, biparietal distance, and Jaw Index. Otolaryngology teams were present at delivery for a subset of cases, with various interventions performed, including tracheostomy and intubation. Lower gestational age at birth, rather than more severe quantitative measurements, was associated with the need for intervention. Intubation failure due to airway difficulty was also predicted by lower gestational age.ConclusionWhile certain quantitative fetal imaging measurements are often used for clinical decision‐making regarding airway management at birth, they did not clearly predict the need for airway intervention in our sample. Gestational age is an important consideration in decision‐making for fetal teams and should be considered in preterm fetuses to plan for airway difficulties. The findings highlight the complexity of fetal micrognathia management and highlight the need for further research to refine predictive models and optimize clinical decision‐making in this challenging clinical scenario.Level of EvidenceLevel 3 Laryngoscope, 2024

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Ex Utero Intrapartum Treatment of Fetal Micrognathia

Cited by 3 publications

References 4 publications

Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally

Predictive Factors for Perinatal Outcomes of Infants Diagnosed With Micrognathia Antenatally

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

Value of Imaging Measurements in Micrognathia‐Related Fetal Airway Obstruction Within a Fetal Center

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