Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT

Area of Science:

• Fetal Medicine
• Pediatric Surgery
• Obstetrics

Background:

• Fetal airway compromise detection necessitates careful planning for ex utero intrapartum treatment (EXIT) procedures.
• EXIT procedures are resource-intensive and carry risks, yet decisions are often anecdotal.
• Analyzing prenatal imaging and obstetric findings is crucial for optimizing EXIT procedure management strategies.

Purpose of the Study:

• To analyze prenatal consultations for fetal airway obstruction.
• To identify imaging and obstetric findings guiding EXIT procedure decisions.
• To evaluate the association between findings and the need for invasive airway support.

Main Methods:

• Retrospective chart review of prenatal abnormal fetal airway consults (2004-2019).
• Data included demographics, imaging, delivery, and airway management.
• Fisher's exact test compared management decisions, outcomes, and imaging findings.

Main Results:

• Thirty-seven patients were included; common diagnoses were lymphatic malformation, teratoma, and micrognathia.
• Midline neck mass location was the only imaging finding associated with EXIT performance.
• In-utero neck extension, neck vessel compression, polyhydramnios, and micrognathia predicted need for invasive postnatal airway support.

Conclusions:

• Multidisciplinary interpretation of prenatal imaging aids management of fetal airway pathology.
• EXIT procedures are safe and reduce risks associated with neonatal airway obstruction.
• In-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios are key indicators for invasive airway measures at birth, guiding EXIT recommendations.