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Abstract
Anesthesia for fetal and neonatal surgery requires subspecialized knowledge and expertise. Attention to important anatomic, physiologic, and metabolic differences seen in pregnancy and at birth are essential for the optimal care of these patients. Thorough preoperative evaluations tailored intraoperative strategies and careful postoperative management are critical when devising the anesthetic approach for each of these cases.
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2
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Holloway S. Antenatal detection of a thyrocervical teratoma in the third trimester - A case report. Ultrasound 2022; 30:328-332. [PMID: 36969530 PMCID: PMC10034648 DOI: 10.1177/1742271x221091728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Introduction Congenital teratomas are rare with less than 10% found in the cervical region. When they do occur in the neck, they are usually identified during the third trimester and, due to their location, they are associated with polyhydramnios. Case report Cervical teratoma was identified at 32 weeks gestation during a routine scan of a 33-year-old female expecting dichorionic diamniotic twins. Only one twin was affected and referral to a specialist hospital allowed a care plan to be arranged to ensure safe delivery followed by immediate treatment and surgery. To date, both twins are thriving. Discussion Cervical teratomas usually occur in the third trimester and are not always detected prenatally. Although usually benign, their size and location may cause polyhydramnios as well as increasing the risk of neonatal asphyxiation and death. It is therefore essential to assess the foetal neck when polyhydramnios is noted at any third trimester scan, to maximise detection and ensure appropriate multidisciplinary healthcare can be organised to optimise postnatal survival. Conclusion Antenatal detection of a rare cervical teratoma was pivotal in the management and survival of this infant. Ultrasound practitioners must consider the possibility of a neck teratoma in the presence of third trimester polyhydramnios and therefore evaluate carefully foetal head, neck and chest anatomy as part of their examination.
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Affiliation(s)
- Sally Holloway
- Cambridge University Hospital, Cambridge,
UK
- James Paget Hospital, Norwich, UK
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3
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Eswaran S, Kumar P, Kumar S. An Unusual Lesion of Epignathus with Duplicate Tongue and Ranula in a Neonate. Indian J Otolaryngol Head Neck Surg 2022; 74:2617-2619. [PMID: 36452617 PMCID: PMC9702138 DOI: 10.1007/s12070-020-02302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of epignathus (oropharyngeal teratoma) in a neonate, who presented with a midline mass covered with skin and multiple hairs protruding from the Palate and associated with bifid tongue and ranula. With the characteristic presentation, diagnosis of oro/oropharyngeal teratoma was made and a massive internet search revealed very few reported cases of "epignathus". It is unfortunate that the survival of such neonates is only moderate. Prenatal scans and follow up in an institution can prepare the multidisciplinary team to save the child. EXIT procedure to excise the mass or secure the airway, with future repair of the palate is the treatment option available. This case report emphasizes the rare clinical presentation of the disease and the prenatal diagnosis of such a condition can help in prompt decision making and management.
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Affiliation(s)
| | | | - Sunil Kumar
- Lady Hardinge Medical College, New Delhi, India
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4
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Morales CZ, Barrette LX, Vu GH, Kalmar CL, Oliver E, Gebb J, Feygin T, Howell LJ, Javia L, Hedrick HL, Adzick NS, Jackson OA. Postnatal outcomes and risk factor analysis for patients with prenatally diagnosed oropharyngeal masses. Int J Pediatr Otorhinolaryngol 2022; 152:110982. [PMID: 34794813 DOI: 10.1016/j.ijporl.2021.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe our experience treating prenatally diagnosed oropharyngeal masses in a novel, multidisciplinary collaboration. To identifying outcomes and risk factors associated with adverse postnatal outcomes. METHODS This is a sixty-two patient case series at an academic referral center. Patients with prenatally diagnosed oropharyngeal masses were identified through a programmatic database and confirmed in the electronic health record. RESULTS Sixty-two patient with prenatally diagnosed oropharyngeal mass were identified, with prenatal imaging at our institution confirming this diagnosis in fifty-seven patients, short term outcomes analysis conducted on forty-four patients, and long-term outcomes analysis conducted on seventeen patients. The most common pathology was lymphatic malformations (n = 27, 47.4%), followed by teratomas (n = 22, 38.6%). The median mass volume from all available patient imaging (n = 57) was 60.54 cm3 (range 1.73-742.5 cm3). Thirteen pregnancies were interrupted, six infants expired, and thirteen cases had an unknown fetal outcome. Confirmed mortality was 6/57 patients with imaging-confirmed oropharyngeal masses (10.5%). Fourteen (56%) of the surviving patients (n = 25) were delivered by Ex Utero Intrapartum Treatment (EXIT) procedure and the median NICU stay was thirty-six days (range: 3-215 days). There was no association between airway compression/deviation/displacement, stomach size, polyhydramnios, or mass size and mortality. Seventeen patients had more than one year of follow-up (mean 5.3 ± 2.4 years). These seventeen patients underwent general anesthesia a total of ninety-two times (mean 5.4 ± 4.3) and had a total of twenty-three mass-related surgeries. The great majority of patients required an artificial airway at birth, feeding support, and speech/swallow therapy. CONCLUSIONS Oropharyngeal mass involvement of key anatomic structures-the neck, upper thorax, orbit, and ear, has a greater association with mortality than mass size. Regardless of the size and involved structures, oropharyngeal masses are associated with a high burden of intensive medical care and surgical care beginning at or before birth.
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Affiliation(s)
- Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Louis-Xavier Barrette
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Giap H Vu
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward Oliver
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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5
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Spiers A, Legendre G, Biquard F, Descamps P, Corroenne R. Ex utero intrapartum technique (EXIT): Indications, procedure methods and materno-fetal complications - A literature review. J Gynecol Obstet Hum Reprod 2021; 51:102252. [PMID: 34638008 DOI: 10.1016/j.jogoh.2021.102252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022]
Abstract
A congenital malformation of the head, neck or thorax can lead to upper airway compression with a risk of asphyxia or neonatal death. To secure and protect the upper airway, the Ex Utero Intrapartum Therapy (EXIT) procedure has been developed. The procedure allows delivery of the fetus via a hysterotomy while relying on the placenta as the organ of respiration for the fetus prior to clamping of the umbilical cord. A high level of expertise is necessary for successful completion of the EXIT procedure, which is not void of maternal and fetal risks. In this literature review, we present the indications, procedure methods and materno-fetal complications associated with the EXIT procedure.
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6
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Shalev S, Ben-Sira L, Wasserzug O, Shaylor R, Shiran SI, Ekstein M. Utility of three-dimensional modeling of the fetal airway for ex utero intrapartum treatment. J Anesth 2021; 35:595-598. [PMID: 34075478 DOI: 10.1007/s00540-021-02950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/24/2022]
Abstract
Recent technological developments in three-dimensional (3D) printing have created new opportunities for applications in clinical medicine. 3D printing has been adopted for teaching and planning complicated surgeries, including maxillofacial, orthopedic reconstructions, and airway manipulation for one-lung ventilation or airway stenting. We present here the first use of such technology to print a model from in utero imaging for intrapartum treatment planning. A 32-week fetus presented with congenital high airway obstruction syndrome (CHAOS) due to a large cervical lymphatic malformation. An ex utero intrapartum treatment (EXIT) procedure was planned to allow delivery of a viable infant. We printed a 3D model of the fetal airway by printing separate elements: mandible, tongue, mass, larynx, and trachea from the fetal MRI. The elements were stuck together maintaining correct anatomical relationships. Airway planning was then performed in consultation with a pediatric ear nose and throat (ENT) surgeon. 3D modeling in utero presents many challenges: the resolution of the 3D model generated from a fetal MRI is less crisp than from CT images, fetal position may be variable and not in a defined anatomical plane, movement artifact occurs. Nevertheless, pre-procedure simulations with the aid of 3D modeling promoted team cooperation and well-prepared management of the fetus during EXIT.
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Affiliation(s)
- Shahar Shalev
- Division of Anesthesiology, Intensive Care, and Pain Medicine, Tel-Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Liat Ben-Sira
- Department of Radiology, Tel-Aviv Medical Center, The Dana-Dwek Children's Hospital, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Department of Pediatric Otolaryngology, Tel-Aviv Medical Center, The Dana-Dwek Children's Hospital, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ruth Shaylor
- Division of Anesthesiology, Intensive Care, and Pain Medicine, Tel-Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Shelly I Shiran
- Department of Radiology, Tel-Aviv Medical Center, The Dana-Dwek Children's Hospital, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Margaret Ekstein
- Division of Anesthesiology, Intensive Care, and Pain Medicine, Tel-Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, 6 Weizmann Street, 6423906, Tel-Aviv, Israel.
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7
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Wood CL, Zuk J, Rollins MD, Silveira LJ, Feiner JR, Zaretsky M, Chatterjee D. Anesthesia for Maternal-Fetal Interventions: A Survey of Fetal Therapy Centers in the North American Fetal Therapy Network. Fetal Diagn Ther 2021; 48:361-371. [PMID: 33827094 DOI: 10.1159/000514897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A wide range of fetal interventions are performed across fetal therapy centers (FTCs). We hypothesized that there is significant variability in anesthesia staffing and anesthetic techniques. METHODS We conducted an online survey of anesthesiology directors at every FTC within the North American Fetal Therapy Network (NAFTNet). The survey included details of fetal interventions performed in 2018, anesthesia staffing models, anesthetic techniques, fetal monitoring, and postoperative management. RESULTS There was a 92% response rate. Most FTCs are located within an adult hospital and employ a small team of anesthesiologists. There is heterogeneity when evaluating anesthesiology fellowship training and staffing, indicating there is a multidisciplinary specialty team-based approach even within anesthesiology. Minimally invasive fetal interventions were the most commonly performed. The majority of FTCs also performed ex utero intrapartum treatment (EXIT) and open mid-gestation procedures under general anesthesia (GA). Compared to FTCs only performing minimally invasive procedures, FTCs performing open fetal procedures were more likely to have a pediatric surgeon as director and performed more minimally invasive procedures. CONCLUSIONS There is considerable variability in anesthesia staffing, caseload, and anesthetic techniques among FTCs in NAFTNet. Most FTCs used maternal sedation for minimally invasive procedures and GA for EXIT and open fetal surgeries.
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Affiliation(s)
- Cristina L Wood
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeannie Zuk
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mark D Rollins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lori J Silveira
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John R Feiner
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Michael Zaretsky
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Colorado Fetal Care Center, Aurora, Colorado, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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8
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Abstract
Over the last three decades, advances in early diagnosis of fetal anomalies, imaging and surgical techniques have led to a huge expansion in fetal surgery. A small number of specialist centres perform fetal surgery, which involves high-risk anaesthesia for the mother and fetus. The anaesthetist plays an integral role within the large multispecialty and multidisciplinary team, involved in planning and delivering care for complex surgical procedures. This article reviews three fetal surgical procedures, congenital diaphragmatic hernia, myelomeningocele repair and ex-utero intrapartum treatment for airway obstruction. The underlying fetal pathology, surgical management, anaesthetic considerations and risks for both the mother and fetus are described for each. Fundamental to this is the understanding that clear communication and collaboration between all team members is vital to ensure successful outcomes of patients, the mother and the fetus.
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Affiliation(s)
- J R Dick
- Department of Obstetric Anaesthesia, University College Hospital, London, UK
| | - R Wimalasundera
- Department of Obstetrics and Fetal Medicine, University College Hospital, London, UK
| | - R Nandi
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
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9
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Ferschl MB, Rollins MD, Chatterjee D. Error traps in anesthesia for fetal interventions. Paediatr Anaesth 2021; 31:275-281. [PMID: 33394561 DOI: 10.1111/pan.14120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
A wide range of fetal interventions are being performed worldwide to save the fetus's life, prevent permanent fetal organ damage, and allow a successful transition to extrauterine life. However, these are invasive procedures and can be associated with serious complications. This article focuses on promoting a culture of safety by highlighting five common error traps while anesthetizing patients for fetal interventions. They include failure to preserve uteroplacental perfusion and gas exchange, failure to achieve adequate uterine relaxation prior to hysterotomy, failure to monitor the fetus and prepare for fetal/neonatal resuscitation, failure to prepare for maternal hemorrhage, and failure to promptly treat uterine atony. Practical tips for avoiding these serious complications will also be discussed.
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Affiliation(s)
- Marla B Ferschl
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Mark D Rollins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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10
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Scuglia M, Conforti A, Valfrè L, Totonelli G, Iacusso C, Iacobelli BD, Meucci D, Viggiano M, Fusaro F, Diociaiuti A, Morini F, El Hachem M, Bagolan P. Operative Management of Neonatal Lymphatic Malformations: Lesson Learned From 57 Consecutive Cases. Front Pediatr 2021; 9:709223. [PMID: 34490164 PMCID: PMC8416514 DOI: 10.3389/fped.2021.709223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Aim of the study: Lymphatic malformations (LMs) are rare entities, sometimes difficult to treat, that may be life-threatening when intricately connected to airway structures. Invasive treatments are occasionally required, with sclerotherapy considered the treatment of choice and surgery as a second-line approach. The aim of the present study was to evaluate our multidisciplinary team experience in treating newborns affected by LMs requiring operative management, while defining early outcomes. Methods: Retrospective review of all consecutive patients admitted for LMs requiring operative management between January 2000 and January 2019. Patients were mainly characterized based on anatomical district of the LM (and further stratified based on the development of respiratory distress), need for tracheostomy, number of sclerotherapies, indication for surgery, and residual disease beyond the 1st year. Morbidity and mortality were also evaluated. Fisher exact test and Mann-Whitney test were used as appropriate. Statistical significance was set at p < 0.05. Results: Fifty-seven patients were included in the study, 36 with cervicofacial and/or mediastinal LMs and 21 with LMs of other anatomical districts. Due to the risk of developing respiratory distress at birth, patients with cervicofacial and/or mediastinal LMs were divided into two groups (8/36 group A vs. 28/36 group B). Group A patients are at higher risk for tracheostomy (7/8 group A vs. 1/28 group B, p = 0.0001) and more often require surgical reduction of the residual lymphatic abnormality (5/8 group A vs. 4/28 group B, p = 0.013). They also require sclerotherapies more often, but the difference is not statistically significant (8/8 group A vs. 19/28 group B, p = 0.15). Patients with cervicofacial/mediastinal LMs frequently suffer from persistent residual disease beyond the 1st year of life, significantly more often in group A (7/8 group A vs. 12/28 group B, p = 0.043). Conclusion: LMs are rare conditions with potential life-threatening behavior. Their intrinsic clinical complexity requires a multidisciplinary approach to the affected patients. Planning a long-term follow-up is essential because of the late-term problems those patients may experience.
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Affiliation(s)
- Marianna Scuglia
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Congenital Esophageal Disorders Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Totonelli
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Iacusso
- Congenital Esophageal Disorders Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara D Iacobelli
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Milena Viggiano
- Fetal Medicine and Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Fusaro
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
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11
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Lin EE, Nelson O, Isserman RS, Henderson AA, Rintoul NE, Lioy J, Javia LR, Tran KM, Fiadjoe JE. Management of neonatal difficult airway emergencies in the delivery room. Paediatr Anaesth 2020; 30:544-551. [PMID: 32196824 DOI: 10.1111/pan.13859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 01/29/2023]
Abstract
Neonatal airway emergencies in the delivery room are associated with significant morbidity and mortality. Etiologies vary, but often predispose the neonate to life threatening airway obstruction. With the recent expansion of fetal medicine programs, pediatric anesthesiologists are increasingly being asked to care for these patients. In this review, we discuss common etiologies of difficult airway at delivery, management tools and techniques, and surgical approaches.
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Affiliation(s)
- Elaina E Lin
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca S Isserman
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia A Henderson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie E Rintoul
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Janet Lioy
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luv R Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kha M Tran
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Caldeira A, Pacheco J, Fernandes S, Lança F. [The multidisciplinary challenge of anesthesia for ex utero intrapartum treatment: a case report]. Rev Bras Anestesiol 2020; 70:59-62. [PMID: 32171498 DOI: 10.1016/j.bjan.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022] Open
Abstract
The Ex- Utero Intrapartum Treatment (EXIT) is a surgical procedure performed in cases of expected postpartum fetal airway obstruction, allowing the establishment of patent airway while maintaining placental circulation. Anesthesia for EXIT procedure has several specific features such as adequate uterine relaxation, maintenance of maternal blood pressure fetal anesthesia and fetal airway establishment. The anesthesiologist should be aware of these particularities in order to contribute to a favorable outcome. This is a case report of an EXIT procedure performed on a fetus with a cervical lymphangioma with prenatal evidence of partial obstruction of the trachea and risk of post-delivery airway compromise.
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Affiliation(s)
- Alexandre Caldeira
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Serviço de Anestesiologia, Lisboa, Portugal.
| | - Jânia Pacheco
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Serviço de Anestesiologia, Lisboa, Portugal
| | - Sofia Fernandes
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Serviço de Anestesiologia, Lisboa, Portugal
| | - Filipa Lança
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Serviço de Anestesiologia, Lisboa, Portugal
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13
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Abstract
Ex Utero Intrapartum Treatment (EXIT) is a technique developed to safely and efficiently establish cardiopulmonary support at delivery while maintaining placental bypass. Indications for the EXIT approach are expanding and currently include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-separation of conjoined twins. The EXIT technique involves planned partial delivery of the fetus via hysterotomy while maintaining uterine relaxation and placental support, allowing for the establishment of neonatal cardiopulmonary stability in a controlled manner. Fetal interventions performed during EXIT can include endotracheal intubation, tracheostomy, mass excision, removal of a temporary tracheal occlusive device, ECMO cannulation, and others. The most important aspect of an EXIT procedure is the formation of a multi-disciplinary team with broad expertise in fetal intervention to collaborate throughout the pre, intra, and post-partum periods. This chapter reviews the prenatal workup, decision making, surgical indications, and operative considerations associated with EXIT procedures.
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Affiliation(s)
- Christina M Bence
- Children's Hospital of Wisconsin, Medical College of Wisconsin, 999 N. 92nd Street, Suite 320, Milwaukee, WI 53226, USA
| | - Amy J Wagner
- Children's Hospital of Wisconsin, Medical College of Wisconsin, 999 N. 92nd Street, Suite 320, Milwaukee, WI 53226, USA.
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Ravelli A, Napolitano M, Rustico M, Riccipetitoni G, Di Leo G, Righini A, Sardanelli F. Prenatal MRI of neck masses with special focus on the evaluation of foetal airway. Radiol Med 2019; 124:917-925. [PMID: 31175537 DOI: 10.1007/s11547-019-01049-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal magnetic resonance imaging is the best tool to visualize foetal airway. OBJECTIVE To evaluate the performance of MRI in the assessment of foetal airway status in the presence of a neck mass. MATERIALS AND METHODS Two paediatric radiologists with 12- and 2-year experience in foetal imaging retrospectively analysed 23 foetal MRI examinations, performed between 2001 and 2016, after a second-level ultrasound suspicious for presence of a neck mass. Postnatal imaging, postoperative report, histology, autopsy, and clinical outcomes were the reference standard to calculate sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of prenatal MRI in detecting airway patency. We used the Cohen к statistics to estimate the interobserver agreement. We also assessed MRI performance in the diagnosis of the mass nature. RESULTS We obtained data about postnatal airway status in 19 of 23 patients; prenatal MRI demonstrated a sensitivity of 9/9 [100%, 95% confidence interval (CI) 66-100%], specificity 8/10 (80%, 44-98%), accuracy 17/19 (89%, 67-99%), PPV 9/11 (82%, 48-98%), and NPV 8/8 (100%, 63-100%); the interobserver agreement was perfect. Prenatal MRI correctly identified 21 of 23 masses (к = 0.858); the interobserver agreement was almost perfect (к = 0.851). CONCLUSION Prenatal MRI demonstrated high accuracy in assessing foetal airway status and diagnosing mass nature, allowing proper delivery planning.
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Affiliation(s)
- Anna Ravelli
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy.
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Mariangela Rustico
- Department of Obstetrics and Gynecology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Andrea Righini
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
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15
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Abstract
The growth of the field of fetal surgery over the last two decades driven by new indications and data from prospective randomized trials supporting prenatal intervention has resulted in techniques protocols and methodologies that have gained confidence by insuring good outcomes. Error traps are methods or techniques that usually work well in most of the cases, but which are apt to fail under certain specific circumstances. The very confidence the surgeon develops in these techniques or methodologies makes them a trap for the unwary surgeon. The purpose of this article is to discuss common error traps in fetal interventions, including ultrasound guided procedures, fetoscopic surgery, open fetal surgery and EXIT procedures. Awareness of these error traps and approaches to avoid them may enhance fetal surgical outcomes and reduce complications rates.
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Affiliation(s)
- Jose L Peiro
- Cincinnati Fetal Center, Division of Pediatric General and Thoracic Surgery, College of Medicine at University of Cincinnati, and the Cincinnati Children's Hospital Medical Center (CCHMC). Cincinnati, OH, USA
| | - Timothy M Crombleholme
- Fetal Care Center Dallas, Division of Pediatric Surgery, Department of Surgery, and the Medical City Children's Hospital, Suite C 742, 7777 Forrest Lane, Dallas, TX 75230, USA.
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16
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Kumar M, Gupta A, Kumar V, Handa A, Balliyan M, Meena J, Roychoudhary S. Management of CHAOS by intact cord resuscitation: case report and literature review. J Matern Fetal Neonatal Med 2018; 32:4181-4187. [PMID: 29842812 DOI: 10.1080/14767058.2018.1481951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: Congenital high airway obstruction syndrome (CHAOS) is a near fatal condition, except when the ex utero intrapartum treatment (EXIT) procedure is performed as rescue. After antenatal diagnosis of the condition, counseling regarding prognosis and outcome needs to be provided.Case: We describe here a case with CHAOS due to isolated fetal laryngeal atresia, presented at our center at 33-week gestation. After counseling regarding the uncertain outcome, consent for elective caesarean was not given. Intact cord resuscitation (ICR) was done as a rescue by a well-coordinated team during delivery. Tracheostomy was performed successfully under local anesthesia within five minutes, while the cord was still attached to the placenta. The baby had supraglottic stenosis on CT scan. Reconstructive surgery is planned after 8 months. The literature review showed 24 reports of 28 cases with intrinsic airway obstruction managed by EXIT, laryngeal atresia was the most common cause (18/28). The outcome was poor in tracheal agenesis (1/4 survived) whereas those having laryngeal web or small communication (4/4 survived) had better outcome. Tracheal reconstruction was done in 3/28 cases only.Conclusions: The case emphasizes that ICR and tracheostomy during vaginal delivery can rescue the baby. The literature reviewed provided insight into the outcome of CHAOS cases in world literature.
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Affiliation(s)
| | - Amit Gupta
- Lady Hardinge Medical College, New Delhi, India
| | - Vijay Kumar
- Lady Hardinge Medical College, New Delhi, India
| | - Anu Handa
- Lady Hardinge Medical College, New Delhi, India
| | | | - Jyoti Meena
- All India Institute of Medical Sciences, New Delhi, India
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17
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Olivares E, Castellow J, Khan J, Grasso S, Fong V. Massive fetal cervical teratoma managed with the ex utero intrapartum treatment (EXIT) procedure. Radiol Case Rep 2018; 13:389-391. [PMID: 29904479 PMCID: PMC5999839 DOI: 10.1016/j.radcr.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/09/2017] [Indexed: 12/18/2022] Open
Abstract
Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor.
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Affiliation(s)
- Emily Olivares
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Justin Castellow
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Jamil Khan
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Susanne Grasso
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Victor Fong
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
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18
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Abstract
Intrauterine surgery is being performed with increasing frequency. Correction of foetal anomalies in utero can result in normal growth of foetus and a healthier baby at delivery. Intrauterine surgery can also improve the survival of babies who would have otherwise died at delivery, or in the neonatal period. There are three commonly used approaches to correct foetal anomalies: open surgery, where the foetus is exposed through hysterotomy; percutaneous approach, where needle or foetoscope is inserted through the abdominal wall and the uterine wall; finally, ex utero intrapartum treatment (EXIT) surgery, where the intervention is performed on the baby before terminating the maternal umbilical support to the baby. Anaesthetic management of the mother and the foetus requires good understanding of maternal physiology, foetal physiology, and pharmacological and surgical implications to the foetus. Uterine relaxation is a critical requisite for open foetal procedures and EXIT procedures. General anaesthesia and/or regional anaesthesia can be used successfully depending on the nature of foetal intervention. Foetal surgery poses complications not only to the foetus but also to the mother. Therefore, the decision for undertaking foetal surgery should always consider the risk to the mother versus benefit to the foetus.
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Affiliation(s)
| | - Shobana Bharadwaj
- University of Maryland Medical Center, University of Maryland, Baltimore, Maryland, USA
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19
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Pucher B, Szydlowski J, Jonczyk-Potoczna K, Sroczynski J. The EXIT (ex-utero intrapartum treatment) procedure - from the paediatric ENT perspective. ACTA ACUST UNITED AC 2017; 38:480-484. [PMID: 29187760 PMCID: PMC6265671 DOI: 10.14639/0392-100x-1261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 03/21/2017] [Indexed: 12/02/2022]
Abstract
The main principle of the EXIT procedure is to maintain uteroplacental circulation with neonatal anaesthesia by controlled uterine hypotonia. This enables securing the foetal airways and decompress or resect large neck and mediastinal foetal masses. The authors present their experience with use of the EXIT procedure in 7 foetuses in whom evaluation and management of the airways were performed. In 4 patients, the neck mass was surgically removed in the neonatal period, in 1 the propranolol treatment was introduced. Two newborns died shortly after the EXIT procedure. The EXIT procedure allows the paediatric otolaryngologist to provide airway patency of newborns during delivery. Both ultrasound and MR imaging are crucial in the prenatal assessment of foetal head and neck masses. Their application in the evaluation of any foetal anomaly is essential for proper prognosis and treatment. Maternal monitoring for complications such as polyhydramnios and preterm labour are important in planning and desirability of the EXIT procedure.
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Affiliation(s)
- B Pucher
- Department of Paediatric Otolaryngology, Poznan University of Medical Sciences, Poland
| | - J Szydlowski
- Department of Paediatric Otolaryngology, Poznan University of Medical Sciences, Poland
| | - K Jonczyk-Potoczna
- Department of Paediatric Radiology, Poznan University of Medical Sciences, Poland
| | - J Sroczynski
- Department of Paediatric Otolaryngology, Poznan University of Medical Sciences, Poland
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20
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Thawani JP, Randazzo MJ, Singh N, Pisapia JM, Abdullah KG, Storm PB. Management of Giant Cervical Teratoma with Intracranial Extension Diagnosed in Utero. J Neurol Surg Rep 2016; 77:e118-20. [PMID: 27468407 DOI: 10.1055/s-0036-1586211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cervical teratomas are rare germ cell tumors affecting the fetus that are associated with significant morbidity and mortality due to an increased risk of airway obstruction at delivery. These tumors can commonly produce polyhydramnios that results from the fetus' impaired ability to swallow amniotic fluid. Improved rates of prenatal diagnosis through comprehensive evaluations and imaging have dramatically impacted the perinatal management of infants with this condition. Here, we report a patient diagnosed with polyhydramnios whose fetus was discovered to have a giant cervical teratoma on imaging studies. The child underwent surgical resection after having the airway secured under the uteroplacental support as part of an ex utero intrapartum treatment procedure performed at 37 weeks. The following gross pathological and magnetic resonance images demonstrate this condition and its currently accepted treatment.
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21
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Oliveira E, Pereira P, Retroz C, Mártires E. Anesthesia for EXIT procedure (ex utero intrapartum treatment) in congenital cervical malformation--a challenge to the anesthesiologist. Braz J Anesthesiol 2015; 65:529-33. [PMID: 26614154 DOI: 10.1016/j.bjane.2013.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
The ex utero intrapartum treatment (EXIT) procedure consists of partial externalization of the fetus from the uterine cavity during delivery, allowing the maintenance of placental circulation. It is indicated in the presence of congenital malformation when difficulty in fetal airway access is anticipated, allowing it to be ensured by direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. Anesthesia for EXIT procedure has several special features, such as the appropriate uterine relaxation, maintenance of maternal blood pressure, fetal airway establishment, and maintenance of postpartum uterine contraction. The anesthesiologist should be prepared for the anesthetic particularities of this procedure in order to contribute to a favorable outcome for the mother and particularly the fetus.
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Affiliation(s)
- Elsa Oliveira
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Paula Pereira
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Retroz
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Emília Mártires
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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22
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Zielinski R, Respondek-Liberska M. Retrospective chart review of 44 fetuses with cervicofacial tumors in the sonographic assessment. Int J Pediatr Otorhinolaryngol 2015; 79:363-8. [PMID: 25600283 DOI: 10.1016/j.ijporl.2014.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to review and analyze ultrasonography examinations and follow-up of fetuses with cervicofacial tumors to develop bases for counseling specialist involved in perinatal treatment. METHODS The study consisted of case series with chart review of 44 fetuses with cervicofacial tumors diagnosed in utero by ultrasonography. The study was carried in Department of Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz in years 1998-2013. The analysis of the fetuses with cervicofacial tumors included assessment of fetal sonographic features, neonatal survival and in utero as well as perinatal treatments. The obtained data were analyzed by the standard statistical tests and the Pearson's Chi square test, statistical significance at p=0.05. RESULTS Cervicofacial tumors were detected at mean 19±7 weeks of gestation. Eighty-two percent of the fetuses were males. Lymphatic malformations followed by teratomas were the most common fetal tumors in the cervicofacial region. In most cases, fetuses with cervicofacial tumors had other abnormalities. Mortality rate in our case series was 43%. In utero treatment was introduced in 6 fetuses. In 4 neonates prenatal sonographic assessment revealed upper airway patency and EXIT procedure (ex-utero intrapartum treatment) was introduced. CONCLUSION Prenatal sonographic detection of cervicofacial tumor, in case of lymphatic malformations possibly as early as in the first trimester, in case of craniofacial teratomas, cervical teratomas, hemangiomas and thyroid tumors possibly as early as in the second trimester, and in case of epignathi possibly in the third trimester, permits planning further course of pregnancy as well as EXIT procedure before delivery.
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Affiliation(s)
- Rafal Zielinski
- Department of Pediatric Otorhinolaryngology, Medical University of Lodz, Poland.
| | - Maria Respondek-Liberska
- Department of Diagnosis and Prevention of Congenital Malformations, Polish Mother Memorial Hospital, Chair of Morphology and Embryology, Medical University of Lodz, Poland
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23
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Dakpé S, Demeer B, Cordonnier C, Devauchelle B. Emergency management of a congenital teratoma of the oral cavity at birth and three-year follow-up. Int J Oral Maxillofac Surg 2014; 43:433-6. [PMID: 24467932 DOI: 10.1016/j.ijom.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/02/2013] [Accepted: 09/03/2013] [Indexed: 12/30/2022]
Abstract
Teratomas are congenital malformations that are rarely located in the head and neck region. We report a case of congenital teratoma of the oral cavity, which was causing an airway obstruction and was treated at the time of birth. This teratoma was discovered at 27 gestational weeks by ultrasonography. A multidisciplinary team was consulted for antenatal diagnosis; the options of therapeutic abortion or management of the birth with the prevention of respiratory distress were debated. However, preterm labour at 32 gestational weeks accelerated the parental and the medical decisions. The parents agreed to the birth. The various disciplines coordinated their work, and the predefined treatment plan for clearing the airway obstruction was applied to manage the birth. The reestablishment of patency of the airway was performed during delivery and removal of the tumour was performed immediately afterwards. The follow-up of this case over 3 years is also presented.
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Affiliation(s)
- S Dakpé
- Department of Maxillofacial Surgery and Stomatology, University Hospital Amiens, France.
| | - B Demeer
- Department of Prenatal Diagnosis, Gynaecology and Obstetrics, University Hospital Amiens, France; Department of Medical Genetics, Rare Disease Centre, University Hospital Amiens, France
| | - C Cordonnier
- Department of Anatomopathology, University Hospital Amiens, France
| | - B Devauchelle
- Department of Maxillofacial Surgery and Stomatology, University Hospital Amiens, France
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24
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Owusu-Brackett N, Johnson R, Schindel DT, Koduru P, Cope-Yokoyama S. A novel ALK rearrangement in an inflammatory myofibroblastic tumor in a neonate. Cancer Genet 2013; 206:353-6. [PMID: 24290361 DOI: 10.1016/j.cancergen.2013.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/04/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
Inflammatory myofibroblastic tumors (IMTs) are uncommon lesions primarily affecting children and young adults. They have rarely been described in infants, with a very small number described in neonates. Structural rearrangements in the anaplastic large-cell lymphoma kinase gene (ALK) has contributed to our categorizing this lesion as a neoplasm. In addition, rearrangements of the ALK gene have been implicated in the pathogenicity of many other hematolymphoid and non-hematolymphoid tumors, typically involving 2p23 with different partners or with pericentric inversion. We report a previously undescribed cryptic deletion and intrachromosomal-insertional translocation of the 3'-region of the ALK gene from 2p23 to the 2q33-q35 in an IMT of a newborn patient with an apparently normal G-band karyotype of the tumor.
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25
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Abstract
This article describes the anesthetic management of pregnant women undergoing fetal surgery. Discussion includes general principles common to all fetal surgeries as well as specifics pertaining to open fetal surgery, minimally invasive fetal surgery, and ex utero intrapartum therapy (EXIT) procedures.
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Affiliation(s)
- Hans P Sviggum
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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26
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Dray G, Olivier C, Teissier N, Vuillard E, Michel J, Farnoux C, Sibony O, Oury JF. [Epignathus teratoma: diagnostic and neonatal management; a case report]. ACTA ACUST UNITED AC 2013; 42:596-601. [PMID: 23684541 DOI: 10.1016/j.jgyn.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 12/03/2012] [Accepted: 12/11/2012] [Indexed: 10/26/2022]
Abstract
Epignathus teratoma is a rare tumor whose prognosis essentially depends on its resectability and on neonatal care. When it is undiagnosed prenatally, mortality is close to 100 % at birth, because of obstruction of the upper airways. We present a case of epignathus teratoma detected during obstetrical ultrasound screening. Diagnosis enabled planning for a safe delivery in a suitable multidisciplinary unit and use of the EXIT procedure.
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Affiliation(s)
- G Dray
- Service de gynécologie-obstétrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
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