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ex-utero intrapartum treatment

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https://www.readbyqxmd.com/read/27836357/does-the-ex-utero-intrapartum-treatment-to-extracorporeal-membrane-oxygenation-procedure-change-morbidity-outcomes-for-high-risk-congenital-diaphragmatic-hernia-survivors
#1
Hester F Shieh, Jay M Wilson, Catherine A Sheils, C Jason Smithers, Virginia S Kharasch, Ronald E Becker, Mollie Studley, Donna Morash, Terry L Buchmiller
PURPOSE: In high-risk congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before extracorporeal membrane oxygenation (ECMO) can be initiated. We previously examined ex utero intrapartum treatment (EXIT)-to-ECMO in our most severe CDH patients, but demonstrated no survival advantage. We now report morbidity outcomes in survivors of this high-risk cohort to determine whether EXIT-to-ECMO conferred any benefit. METHODS: All CDH survivors with <15% predicted lung volume (PPLV) from September 1999 to December 2010 were included...
October 25, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#2
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27645029/ep21-23-ex-utero-intrapartum-treatment-exit-procedure-for-cervical-teratoma
#3
K Maeda, D Nakaoku, M Murakami, A Kondo, M Morine, K Hinokio, T Kaji
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27483657/-a-case-of-exit-ex-utero-intrapartum-treatment-in-a-fetus-with-prenatal-diagnosis-of-a-giant-cervical-tumor-successful-airway-management-but-without-indication-of-treatment-for-a-tumor
#4
Chikako Masamoto, Hiroyasu Onishi, Yumi Doi, Ikuo Uekita, Tetsuro Kagawa
The ex-utero intrapartum treatment (EXIT) is a rare procedure, and often comes as an emergency surgery. A careful preparation is crucial and a multidisciplinary team discussion during the prenatal period is necessary because it may be practically and ethically difficult to plan a surgical treatment for a fetus for EXIT. An elective caesarean section and EXIT for a fetus with a giant cervical tumor, which may cause airway obstruction and difficult intubation, were scheduled. The anesthesiologist tried oral intubation by direct laryngoscope; however, neither blade nor rigid bronchoscope insertion was impossible as a firm mass protruded in oral cavity from the left side...
June 2016: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/27468407/management-of-giant-cervical-teratoma-with-intracranial-extension-diagnosed-in-utero
#5
Jayesh P Thawani, Michael J Randazzo, Nickpreet Singh, Jared M Pisapia, Kalil G Abdullah, Phillip B Storm
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...
July 2016: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/27258179/otocephaly-complex-case-report-literature-review-and-ethical-considerations
#6
Jack Diep, David Kam, Farrah Munir, Steven M Shulman, Glen Atlas
Otocephaly complex is a rare and usually lethal syndrome characterized by a set of malformations consisting of microstomia, mandibular hypoplasia/agnathia, and ventromedial malposition of the ears. Those cases that have been diagnosed prenatally have used an ex utero intrapartum treatment procedure to establish a definitive airway. However, prenatal diagnosis continues to be challenging, primarily because of poor diagnostic sensitivity associated with ultrasonography. We present a case of a newborn with an unanticipated otocephaly complex requiring emergent airway management...
July 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27185679/anesthetic-management-of-an-ex-utero-intrapartum-treatment-procedure-a-novel-balanced-approach
#7
Adam Braden, Christopher Maani, Christopher Nagy
Ex utero intrapartum treatment (EXIT) procedures are therapeutic interventions for fetuses with life-threatening airway abnormalities and/or other prenatally diagnosed congenital malformations requiring immediate neonatal extracorporeal membrane oxygenation support. Although certain anesthetic goals are common among EXIT procedures, many different approaches to their management have been described in the literature. Herein, we present a novel anesthetic approach to an EXIT procedure for fetal micrognathia and retrognathia...
June 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27134307/a-modified-exit-to-ecmo-with-optional-reservoir-circuit-for-use-during-an-exit-procedure-requiring-thoracic-surgery
#8
Gregory S Matte, Kevin R Connor, Nathalia A Toutenel, Danielle Gottlieb, Francis Fynn-Thompson
A 34 year old mother with a history of polyhydraminos and premature rupture of membranes presented for an ex utero intrapartum treatment (EXIT) procedure to deliver her 34 week gestation fetus. The fetus had been diagnosed with a large cervical mass which significantly extended into the right chest. The mass compressed and deviated the airway and major neck vessels posteriorly. Imaging also revealed possible tumor involvement with the superior vena cava and right atrium. The plan was for potential extracorporeal membrane oxygenation (ECMO) during the EXIT procedure (EXIT-to-ECMO) and the potential for traditional cardiopulmonary bypass (CPB) for mediastinal tumor resection...
March 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27132111/immediate-operative-management-of-the-fetus-with-airway-anomalies-resulting-from-congenital-malformations
#9
REVIEW
Pablo Laje, Sasha J Tharakan, Holly L Hedrick
Prenatal diagnosis has transformed the outcome of fetuses with airway obstruction. The thorough evaluation of prenatal imaging allows for categorizing fetuses with airway compromise into those who will require a special mode of delivery and those who can be delivered without any special resources. The ex-utero intrapartum treatment (EXIT) approach allows accessing the airway while the fetus is under placental support, converting a potentially catastrophic situation into a controlled one. An expert multidisciplinary team is the key to success...
August 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/26899001/-prenatal-diagnosis-and-intervention-to-fetal-hydrothorax-five-cases-analysis
#10
Zhitao Zhang, Shanshan Zhang, Shaowei Yin, Shanshan Liao, Caixia Liu
OBJECTIVE: To research the important of prenatal diagnosis and effect of intervention to fetal hydrothorax. METHODS: The cases of fetal hydrothorax (n=5) were obtained from the Shengjing Hospital, China Medical University between December 2014 and May 2015. All pregnancies were uncomplicated, excluded congenital organic and chromosomal abnormalities during prenatal diagnosis and with a 37 average gestational weeks. The case 1, 2, 4 were unilateral hydrothorax and the case 3, 5 were bilateral...
January 2016: Zhonghua Fu Chan Ke za Zhi
https://www.readbyqxmd.com/read/26882580/early-onset-sepsis
#11
REVIEW
Kyrsten Johnson, Stephen Messier
Early onset sepsis (EOS) is a worrisome, life-threatening condition in newborns with onset during the first week of life. Evaluation can be challenging due to the dynamic nature of the condition as the infant transitions to life ex-utero. Symptoms/signs can be nonspecific, thus, a high index of suspicion is warranted for subtle changes in condition including poor feeding, respiratory distress, or decreased activity. Common risk factors include chorioamnionitis, maternal fever, group B strep (GBS) colonization and preterm delivery...
January 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/26655714/-anesthesia-for-ex-utero-intrapartum-treatment-renewed-insight-on-a-rare-procedure
#12
Miguel Vieira Marques, João Carneiro, Marta Adriano, Filipa Lança
The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise...
November 2015: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/26614154/anesthesia-for-exit-procedure-ex-utero-intrapartum-treatment-in-congenital-cervical-malformation-a-challenge-to-the-anesthesiologist
#13
Elsa Oliveira, Paula Pereira, Carla Retroz, Emília Mártires
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...
November 2015: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/26614153/anesthesia-for-ex-utero-intrapartum-treatment-renewed-insight-on-a-rare-procedure
#14
Miguel Vieira Marques, João Carneiro, Marta Adriano, Filipa Lança
The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise...
November 2015: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/26595008/total-airway-reconstruction-in-the-neonate-combined-mandibular-distraction-and-slide-tracheoplasty-for-multiple-level-airway-obstruction
#15
Marten N Basta, Pamela A Mudd, Stephanie M Fuller, Luv R Javia, Jesse A Taylor
BACKGROUND: Long-segment congenital tracheal stenosis (CTS) is characterized by segmental tracheal stenosis, complete tracheal rings, and absent posterior pars membranosa for >50% of tracheal length. Slide tracheoplasty on cardiopulmonary bypass (CPB) has traditionally been the procedure of choice for airway reconstruction. Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. The authors and others, have demonstrated the efficacy of mandibular distraction osteogenesis (MDO) to avoid tracheostomy in severe cases of PRS...
November 2015: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/26499019/ex-utero-intrapartum-treatment-exit-procedure-for-giant-fetal-epignathus
#16
Pooja Agarwal Jayagobi, Suresh Chandran, Bhavani Sriram, Kenneth T E Chang
BACKGROUND: Large fetal oropharyngeal tumors are rare, and have the potential to cause airway obstruction during birth. CASE CHARACTERISTICS: A 35-year-old woman with antenatally diagnosed large heterogenous mass in fetal neck displacing trachea and filling up the orophanygeal space. INTERVENTION: The infant was delivered at 31 weeks of gestation by ex-utero intrapartum therapy procedure to secure the airway. OUTCOME: Tumor was resected successfully on day 8 of life...
October 2015: Indian Pediatrics
https://www.readbyqxmd.com/read/26438708/antenatal-three-dimensional-printing-of-aberrant-facial-anatomy
#17
Kyle K VanKoevering, Robert J Morrison, Sanjay P Prabhu, Maria F Ladino Torres, George B Mychaliska, Marjorie C Treadwell, Scott J Hollister, Glenn E Green
Congenital airway obstruction poses a life-threatening challenge to the newborn. We present the first case of three-dimensional (3D) modeling and 3D printing of complex fetal maxillofacial anatomy after prenatal ultrasound indicated potential upper airway obstruction from a midline mass of the maxilla. Using fetal MRI and patient-specific computer-aided modeling, the craniofacial anatomy of the fetus was manufactured using a 3D printer. This model demonstrated the mass to be isolated to the upper lip and maxilla, suggesting the oral airway to be patent...
November 2015: Pediatrics
https://www.readbyqxmd.com/read/26419098/-two-cases-of-fetuses-with-difficult-airway-that-survived-by-the-exit-ex-utero-intrapartum-treatment-procedure
#18
Tetsuya Kai, Natsuki Ishibe, Yuji Soeda, Mariko Tanaka, Sumio Hoka
We successfully managed two fetuses complicated with suspected airway obstruction after birth by the EXIT (ex utero intrapartum treatment) procedure, whose placental circulation was maintained till their airway was secured during the cesarean section. The first fetus was suspected to have airway obstruction due to a large neck mass. At 36 weeks of gestation, the EXIT procedure was undertaken performing the tracheal intubation successfully by laryngoscope. The second fetus with micrognathia was expected to have airway obstruction after birth...
April 2015: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/26391020/-anesthesia-for-exit-procedure-ex-utero-intrapartum-treatment-in-congenital-cervical-malformation-a-challenge-to-the-anesthesiologist
#19
Elsa Oliveira, Paula Pereira, Carla Retroz, Emília Mártires
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...
November 2015: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/26221401/anesthetic-management-of-a-neonate-receiving-prenatal-repair-of-gastroschisis
#20
Dong Luo, Lan Wu, Hai Wu, Wei Huang, Han Huang
Gastroschisis requires surgical repair, which is generally performed after birth. We report a case in which a fetus with gastroschisis underwent the abdominal wall defect repair before birth. To ensure reliable operating conditions for the repair (to prevent fetal movement and crying), the fetus received deep anesthesia via placental transfer of maternally administered anesthetics. Meanwhile, the ex utero intrapartum treatment procedure was performed to ensure fetal oxygen supply, which was likely to be compromised by the deep fetal anesthesia...
2015: International Journal of Clinical and Experimental Medicine
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