Fetal Evaluation and Airway Management

Prickett, Kara K.; Javia, Luv

doi:10.1016/j.clp.2018.07.003

Cited by 25 publications

(28 citation statements)

References 46 publications

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“…Present studies recommend consideration of cesarean section and an EXIT-to-airway procedure for airway management of severely micrognathic patients [4]. The EXIT-to-airway procedure may be necessary in severe cases of micrognathia; however, there is limited literature on the efficacy of prenatal indices such as the fetal jaw index and polyhydramnios in predicting the severity of airway obstruction at birth and ultimate need for an EXIT-to-airway procedure [7]. In our study, we found that only one patient out of three with abnormal jaw indices (<23) required an EXIT-to-airway procedure.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Airway Management in Micrognathia and Retrognathia Patients Born at Fetal versus Nonfetal Centers

Shahi

Phillips

Meier³

et al. 2020

Fetal Diagn Ther

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Objectives: There is a paucity of evidence to guide the perinatal management of difficult airways in fetuses with micrognathia. We aimed to (1) develop a postnatal grading system based on the extent of airway intervention required at birth to assess the severity of micrognathic airways and (2) compare trends in airway management and outcomes by location of birth [nonfetal center (NFC), defined as a hospital with or without an NICU and no fetal team, versus fetal center (FC), defined as a hospital with an NICU and fetal team]. Methods: We retrospectively reviewed the prenatal and postnatal records of all neonates diagnosed with micrognathia from January 2010 to April 2018 at a quaternary children’s hospital. We developed a novel grading scale, the Micrognathia Grading Scale (MGS), to grade the extent of airway intervention at birth from 0 (no airway intervention) to 4 (requirement of EXIT or advanced airway instrumentation for airway securement). Results: We identified 118 patients with micrognathia. Eighty-nine percent (105/118) were eligible for grading using the MGS. When the MGS was applied, the airway grades were as follows: grade 0 (30%), grade 1 (10%), grade 2 (9%), grade 3 (48%), and grade 4 (4%). A quarter of micrognathic patients with grade 0–2 airways had postnatal hospital readmissions for airway obstruction after birth, of which all were born at NFC. Over 40% of patients with grade 3–4 micrognathic airways required airway intervention within 24 h of birth. Overall, NFC patients had a readmission rate of (27%) for airway obstruction after birth compared to FC patients (17%). Conclusions: Due to the high incidence of grade 3–4 airways on the MGS in micrognathic patients, fetuses with prenatal findings suggestive of micrognathia should be referred to a comprehensive fetal care center capable of handling complex neonatal airways. For grade 0–2 airways, infants frequently had postnatal complications necessitating airway intervention; early referral to a multidisciplinary team for both prenatal and postnatal airway management is recommended.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Airway Management in Micrognathia and Retrognathia Patients Born at Fetal versus Nonfetal Centers

Shahi

Phillips

Meier³

et al. 2020

Fetal Diagn Ther

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“…La IOT es la medida principal de abordaje. En caso de falla, la IOT por broncoscopia y la traqueotomía, son la segunda y tercera opción de manejo 20,21 . En algunos casos será necesaria la resección parcial o completa de la masa para liberar la tráquea de la compresión externa que permita intubar o realizar traqueotomía y acceder a la vía aérea 22 .…”

Section: Discussionunclassified

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello

Mosquera-Hernández

Ardila-Giraldo

et al. 2020

Rev Chil Pediatr

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Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos.Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT.Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, durante la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias.Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complicaciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.

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“…The primary imaging modalities to diagnose fetal airway obstruction include ultrasound and magnetic resonance imaging (MRI) (Figure ). High‐resolution ultrasound examination is often used to assess cystic lesions of the posterior neck, facial clefts, and other nonairway anomalies while fetal MRI is used for congenital diaphragmatic hernia (CDH), congenital high airway obstruction syndrome (CHAOS), and soft tissue masses of the neck or head . Evaluation of the trachea‐esophageal index (TEDI), which is the degree of displacement between the esophagus and the trachea, also provides some guidance as to the expected degree of difficulty in securing the airway.…”

Section: Unique Considerations For Patients Requiring the Exit Proceduresmentioning

confidence: 99%

“…A TEDI score of 4 or less predicts a difficult airway . Other methods such as static imaging and visualization of the fetus swallowing in a high‐resolution ultrasound can be used to determine airway patency with further confirmation by fetal MRI …”

Section: Unique Considerations For Patients Requiring the Exit Proceduresmentioning

confidence: 99%

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Airway management for neonates requiring ex utero intrapartum treatment (EXIT)

Mohammad

Olutoye

2020

Pediatric Anesthesia

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In utero congenital malformations in the fetus can occasionally lead to an obstructed airway at birth accompanied by hypoxic injury or peripartum demise, without intervention. Ex utero intrapartum treatment (EXIT) may help reduce morbidity and mortality associated with challenging airways by providing extra time on uteroplacental circulation to secure the airway. Meticulous preparation and planning are crucial for this procedure. Many different types of congenital malformations can result in a difficult airway, but there is no correlation between specific malformations and a required type of airway intervention. Based on our experience and literature review, an airway process flow diagram has been created to help assist teams in decision‐making for airway intervention in a neonate during the EXIT procedure. The management of the airway in this scenario involves additional unique considerations that accompany handling a partially delivered newborn in the uterine environment. Extensive preparation and team rehearsal are essential to the success of this procedure.

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Fetal Evaluation and Airway Management

Cited by 25 publications

References 46 publications

Outcomes of Airway Management in Micrognathia and Retrognathia Patients Born at Fetal versus Nonfetal Centers

Outcomes of Airway Management in Micrognathia and Retrognathia Patients Born at Fetal versus Nonfetal Centers

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello

Airway management for neonates requiring ex utero intrapartum treatment (EXIT)

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