Perinatal airway management of neonatal cervical teratomas

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• 作者：Kiarash Taghavi^a ; Robert G. Berkowitz^b ; ^c ; ^d ; ^{Robert.Berkowitz@rch.org.au} ; A. Michelle Fink^e ; ^f ; ^g ; Ross D. Farhadieh^h ; Anthony J. Peningtonⁱ ; ^j ; ^k
• 关键词：Cervical teratoma ; Ex-utero intrapartum treatments ; EXIT procedures ; Fetal MRI ; Neonatal airway
• 刊名：International Journal of Pediatric Otorhinolaryngology
• 出版年：2012
• 期刊代码：135_01655876
• 类别：med
• 出版时间：July, 2012
• 卷：76
• 期：7
• 页码：1057-1060
• 文件大小：547 K

摘要

Cervical teratomas are rare but life-threatening neonatal tumors and management of the fetus with a cervical teratoma that threatens the airway remains a clinical challenge. This has been revolutionized by advances in fetal imaging and management of the airway at delivery including the use of Ex-utero Intrapartum Treatments (EXIT procedures). We present a retrospective case series of three neonates managed over a 12-month period. Following pre-natal fetal MRI and a multi-disciplinary management approach, two newborns were managed by prompt post-natal endotracheal intubation while an EXIT procedure was required in one. All three underwent surgical resection in the first few days of life. A decision regarding the best means by which to manage the airway in fetal cervical teratoma requires fetal MRI and a multi-disciplinary team approach to determine whether EXIT, or a safer approach from a maternal perspective can be employed. We also recommend routine endotracheal intubation at birth, due to the risk of spontaneous intra-tumoral hemorrhage. The need for surgery should be planned early, as rapid growth of the tumor can threaten the viability of the overlying skin and surrounding structures.