A rare and difficult procedure gave a new lease of life to a newborn with a large neck mass blocking his airway. The paediatric surgery and neonatology team at BLK Super Speciality Hospital here performed the difficult procedure called Extrauterine Intrapartum Treatment (EXIT).
Antenatal ultrasound scan of a 29-year-old woman from Bihar who was 30 weeks pregnant had revealed a large neck mass on the foetus.
“The patient was referred to our hospital. She was evaluated and a foetal MRI suggested a large neck mass of an approximate size of 10x9 cm. The infant’s airways could not be visualised as the giant cervical mass was compressing it,” noted a release issued by the hospital on Monday.
Life-threatening
The baby’s normal exit from the womb would have been life-threatening as the windpipe was blocked due to the giant neck mass, obstructing passage of oxygen despite its abundant presence. The odds were stacked against the baby’s survival as his windpipe had to be decongested by intubation while he was still in the uterus and keeping umbilical circulation intact throughout the intervention.
Prashant Jain, senior consultant, paediatric surgery, BLK Super Speciality Hospital, said, “When a baby is in the womb, the mother breathes for him/her through the umbilical cord. Once out of the womb, the baby needs to breathe for himself/herself.”
“It would have been fatal for the baby had he exited the womb without undergoing the EXIT procedure. Securing the airway after the baby was delivered could have been difficult because of the distorted anatomy of the neck and the fact that intubation time cannot exceed over 25-30 seconds to prevent brain hypoxia. So the EXIT procedure was the only option left where we would have a little more time to perform the intubation procedure,” Dr. Jain added.
Special C-section
Kumar Ankur, consultant, neonatology, BLK Super Speciality Hospital, added: “The case also required a special C-section to keep the fetoplacental circulation intact. This is only made possible under general anaesthesia with uterine relaxants. However, this carries a high risk of maternal bleeding.”
A special C-section was performed in this case. Only the head and shoulders of the baby were delivered out of uterus and the intubation procedure was conducted swiftly in a record time of 1.32 minutes.
After the windpipe procedure was conducted successfully and the newborn delivered, the non-cancerous tumour on the neck was also operated. Intubation was done away with as his windpipe was decongested thoroughly.
