The ex utero intrapartum therapy procedure for high-risk fetal lung lesions.

Abstract

BACKGROUND:

Indications for the ex utero intrapartum therapy (EXIT) procedure have expanded to include any fetal anomaly in which resuscitation of the neonate may be compromised.

METHODS:

We reviewed the medical records of 9 patients after resection of lung lesions during the EXIT procedure.

RESULTS:

The mean gestational age at EXIT procedure was 35.4 weeks. All lung masses maintained large sizes late into gestation with mean mass volume/head circumference ratio of 2.5 at presentation and 2.2 at EXIT. Seven of 9 fetuses demonstrated hydropic changes (n = 6) and/or polyhydramnios (n = 5), and underwent prenatal intervention including thoracentesis, thoracoamniotic shunt placement, amnioreduction, and/or betamethasone administration. Overall survival after EXIT for lung mass resection was 89%. The average time on placental bypass was 65 minutes. Postnatal complications included reoperation for air leak (n = 1), reoperation for bleeding (n = 1), and death from sepsis and prematurity (n = 1). Venoarterial extracorporeal membrane oxygenation was used in 4 neonates for persistent pulmonary hypertension. Maternal prenatal complications included polyhydramnios (n = 5), preterm labor (n = 4), and chorioamnionitis (n = 1). One mother required perioperative blood transfusion.

CONCLUSION:

The EXIT procedure allows for controlled resection of large fetal lung lesions at delivery, avoiding acute respiratory decompensation related to mediastinal shift, air trapping, and compression of normal lung.

• Authors: Holly L Hedrick, Alan W Flake, Timothy M Crombleholme, Lori J Howell, Mark P Johnson, R Douglas Wilson, N Scott Adzick
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 40 Issue 6 Pg. 1038-43; discussion 1044 (Jun 2005) ISSN: 1531-5037 [Electronic] United States
• PMID: 15991193 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Cystic Adenomatoid Malformation of Lung, Congenital (diagnostic imaging, surgery, therapy)
• Edema
• Extracorporeal Membrane Oxygenation
• Female
• Fetal Diseases (diagnostic imaging, surgery)
• Gestational Age
• Humans
• Hysterotomy
• Lung (embryology)
• Lung Volume Measurements
• Pregnancy
• Pregnancy Outcome
• Prenatal Diagnosis
• Retrospective Studies
• Thoracotomy
• Ultrasonography, Prenatal