Perinatal characteristics and early childhood follow up after ex‐utero intrapartum treatment for head and neck teratomas by prenatal diagnosis. (9th February 2021)

• Record Type: Journal Article
• Authors: Shamshirsaz, Alireza A.; Aalipour, Soroush; Stewart, Kelsey A.; Nassr, Ahmed A.; Furtun, Betul Y.; Erfani, Hadi; Sundgren, Nathan C.; Cortes, Magdalena S.; Donepudi, Roopali V.; Lee, Timothy C.; Mehta, Deepak K.; Kravitz, Elizabeth S.; Asl, Nazli M.; Espinoza, Jimmy; Belfort, Michael A.
• Is Part Of: Prenatal diagnosis. Volume 41:Number 4(2021)
• Page Start: 497
• Page End: 504
• Publication Date: 2021-02-09
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5894
• Languages: English
• ISSNs: 0197-3851

Abstract

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. Key Points: What's already known about this topic? Ex utero intrapartum treatment (EXIT) has changed the outcome of fetuses diagnosed prenatally with large neck masses Prenatal planning is essential for successful fetal and maternal outcomes in fetuses with cervical teratoma What does this study add? Structural neck involvement and development of polyhydramnios are important and may be an indication for EXIT None‐elective EXIT was required in more than half of patients which highpoints the importance of 24/7 availability of an experienced multidisciplinary team More than half of neonates were discharged with a gastrostomy tube More than half of neonates were discharged with permanent cranial nerve injury