Management of fetal head and neck masses: Evaluation of prenatal factors associated with airway obstruction and decision for definitive airway and ex-utero intrapartum treatment at birth

Nicholas Schmoke; Christopher Nemeh; Yeu Sanz Wu; Terri Wilken; Pengchen Wang; Paul Kurlansky; Alexis Maddocks; Chia-Ling Nhan-Chang; Russell Miller; Lynn L Simpson; Vincent Duron

doi:10.1002/pd.6586

Management of fetal head and neck masses: Evaluation of prenatal factors associated with airway obstruction and decision for definitive airway and ex-utero intrapartum treatment at birth

Prenat Diagn. 2024 May 9. doi: 10.1002/pd.6586. Online ahead of print.

Authors

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
² Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, New York, USA.
³ Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
⁴ Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
⁵ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.

PMID: 38725046
DOI: 10.1002/pd.6586

Abstract

Objective: Fetal head and neck masses can result in critical airway obstruction. Our study aimed to evaluate prenatal factors associated with the decision for a definitive airway, including ex-utero intrapartum treatment (EXIT), at birth among at-risk fetuses.

Methods: A single-institution retrospective review evaluated all fetal head and neck masses prenatally diagnosed from 2005 to 2023. The primary outcome was the decision for a definitive airway at birth, including intubation, tracheostomy, or EXIT.

Results: Thirty four patients were included, with 23 deliveries occurring at our institution. 8/23 (35%) patients received a definitive airway at birth, six underwent an EXIT procedure, and two required intubation only. Patients who received a definitive airway had higher rates of polyhydramnios (50% vs. 7%, p = 0.03), tracheal narrowing on ultrasound (US) (50% vs. 0%, p = 0.01), tracheal displacement on US (63% vs. 0%, p < 0.01), abnormal fetal breathing on US (50% vs. 0%, p = 0.01), tracheal narrowing or displacement on magnetic resonance imaging (MRI) (75% vs. 7%, p < 0.01), and larger mass maximum diameter (7.9 vs. 4.3 cm, p = 0.02). In our series, 100% of patients with polyhydramnios, tracheal narrowing or displacement on either US or MRI, and abnormal fetal breathing on US received a definitive airway at birth.

Conclusion: Prenatal findings of tracheal narrowing or displacement, polyhydramnios, and abnormal fetal breathing are strongly associated with the decision for a definitive airway at birth and warrant mobilization of appropriate resources.