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An interventional airway delivery service for congenital high airway obstruction

Published online by Cambridge University Press:  05 August 2015

M M C Yaneza ,
A Cameron ,
W A Clement ,
R Fairgrieve ,
M A Ledingham ,
M S Morrissey ,
J Simpson ,
D M Wynne  and
H Kubba
M M C Yaneza*
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
A Cameron
Affiliation:
Ian Donald Fetal Medicine Unit, The Southern General Hospital, Glasgow, UK
W A Clement
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
R Fairgrieve
Affiliation:
Department of Paediatric Anaesthetics, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
M A Ledingham
Affiliation:
Ian Donald Fetal Medicine Unit, The Southern General Hospital, Glasgow, UK
M S Morrissey
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
J Simpson
Affiliation:
Department of Neonatology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
D M Wynne
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
H Kubba
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
*
Address for correspondence: Miss M M C Yaneza c/o Mr H Kubba, Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK Fax: 0141 201 0865 E-mail: [email protected]
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Abstract

Background:

Congenital airway obstruction is rare but potentially fatal. We developed a complex airways interventional delivery team to manage such cases. Antenatal imaging detects airway compromise at an early stage and facilitates the planning of delivery procedures (‘ex utero intrapartum treatment’ and ‘operation on placental support’) which maintain feto-placental circulation whilst an airway is secured.

Method:

A retrospective review was performed of cases in which ENT input was required at birth for airway obstruction.

Results:

Four neonates were delivered before implementation of the service: two were intubated and another two underwent tracheostomy but died in the peri-natal period. Seven neonates were delivered after implementation of the service: six were intubated and one underwent immediate tracheostomy. Five subsequently underwent tracheostomy (three have since been decannulated). One child with multiple congenital anomalies died due to respiratory failure. Airway obstruction was caused by lymphatic malformation, teratoma, costo-craniomandibular syndrome and choristoma.

Conclusion:

In the absence of other anomalies, interventional airway delivery led to reduced mortality and improved outcomes.

Keywords

Airway ObstructionPerinatal CareCaesarean sectionOtolaryngologyObstetricsPolyhydramnios
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 8 , August 2015 , pp. 795 - 800
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented as an oral presentation at the 14th British Academic Conference in Otolaryngology, 4–7 July 2012, Glasgow, Scotland, UK

References

1McDevitt, H, Kubba, H, Macara, L, Reynolds, B, Simpson, J. Four cases of congenital airway obstruction: optimising perinatal management. Acta Paediatr 2007;96:1542–5CrossRefGoogle ScholarPubMed
2Osborn, AJ, Baud, D, Macarthur, AJ, Propst, EJ, Forte, V, Blaser, SM et al. Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned. Prenat Diagn 2013;33:1080–7CrossRefGoogle ScholarPubMed
3National ECMO Service for England. Department of Health. In: http://www.leicestershospitals.nhs.uk/EasysiteWeb/getresource.axd?AssetID=787&type=full&servicetype=Attachment [11 November 2014]Google Scholar
4Farrell, PT. Prenatal diagnosis and intrapartum management of neck masses causing airway obstruction. Paediatr Anaesth 2004;14:48–52CrossRefGoogle ScholarPubMed
5Skarsgard, ED, Chitkara, U, Krane, EJ, Riley, ET, Halamek, LP, Dedo, HH. The OOPS procedure (operation on placental support): in utero airway management of the fetus with prenatally diagnosed tracheal obstruction. J Pediatr Surg 1996;31:826–8CrossRefGoogle ScholarPubMed
6George, R, Melnick, A, Rose, E. Case series: combined spinal epidural anesthesia for cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth 2007;54:218–22CrossRefGoogle ScholarPubMed
7Govindarajan, A, Atkinson, S. Combined spinal epidural anaesthesia for ex utero intrapartum treatment (EXIT) procedure. Anaesthesia 2009;64:793–4CrossRefGoogle Scholar
8Abraham, RJ, Sau, A, Maxwell, D. A review of the EXIT (ex utero intrapartum treatment) procedure. J Obstet Gynaecol 2010;30:1–5CrossRefGoogle ScholarPubMed