Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT
Editor's Note: This Manuscript was accepted for publication on June 30, 2020.
This work was supported by a National Institute for Deafness and Other Communication Disorders grant (T32DC000018) (PI: Edward Weaver).
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
We would like to thank senior biostatistician Kathryn Whitlock for her guidance with respect to the statistical analysis for this project.
Meeting Information: Poster presented at the American Society of Pediatric Otolaryngology Meeting at the Combined Otolaryngology Spring Meetings, Austin, TX, USA, May 1–5, 2019.
Abstract
Objective
Detection of fetal airway compromise through imaging raises the possible need for ex utero intrapartum treatment (EXIT) procedures. Despite EXIT procedures involving massive resource utilization and posing increased risk to the mother, decisions for EXIT are usually based on anecdotal experience. Our objectives were to analyze prenatal consultations with potential fetal airway obstruction for imaging and obstetric findings used to determine management strategy.
Methods
Retrospective chart review was performed for prenatal abnormal fetal airway consults between 2004–2019 at a quaternary pediatric facility. Data collected included demographics, imaging characteristics, delivery information, and airway management. Our primary outcome was EXIT performance and the secondary outcome was postnatal airway management. Fisher's exact test was used to compare management decisions, outcomes, and imaging findings.
Results
Thirty-seven patients met inclusion criteria. The most common diagnoses observed were lymphatic malformation, teratoma, and micrognathia. Of the imaging findings collected, only midline neck mass location was associated with EXIT procedure performance. Factors associated with invasive airway support at birth were mass-induced in-utero neck extension and neck vessel compression, polyhydramnios, and micrognathia.
Conclusions
Multidisciplinary input and interpretation of prenatal imaging can guide management of fetal airway-related pathology. EXIT is an overall safe procedure and can decrease risk due to airway obstruction at birth. We identified in-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios as better indicators of a need for invasive airways measures at birth and suggest use of these criteria in combination with clinical judgement when recommending EXIT.
Level of Evidence
4 Laryngoscope, 131:E1357–E1362, 2021
