TY - JOUR
T1 - Cervical lymphatic malformations
T2 - Prenatal characteristics and ex utero intrapartum treatment
AU - Shamshirsaz, Alireza A.
AU - Stewart, Kelsey A.
AU - Erfani, Hadi
AU - Nassr, Ahmed A.
AU - Sundgren, Nathan C.
AU - Mehollin-Ray, Amy R.
AU - Morris, Shaine A.
AU - Espinoza, Jimmy
AU - Sanz Cortes, Magdalena
AU - Cassady, Christopher
AU - Lee, Timothy C.
AU - Castro, Eumenia C.
AU - Olutoye, Olutoyin A.
AU - Mehta, Deepak K.
AU - Cass, Darrell
AU - Olutoye, Oluyinka O.
AU - Belfort, Michael A.
N1 - Funding Information:
This study was supported by the Baylor College of Medicine.
Publisher Copyright:
© 2019 John Wiley & Sons, Ltd.
PY - 2019/3
Y1 - 2019/3
N2 - Background: The ex utero intrapartum treatment (EXIT) is utilized to transition fetuses with prenatally diagnosed airway obstruction to postnatal life. We describe the unique clinical course, diagnosis, treatment, and outcomes of patients with cervical lymphatic malformation (CLM) managed with EXIT. Methods: Review of fetuses with diagnosed CLM was delivered by EXIT (2001-2018) in a tertiary referral fetal center. Outcomes included survival, tracheostomy at discharge, neonatal course after delivery, and pulmonary hypoplasia. Data are reported as median [range] and rate (%). Results: Out of 45 patients delivered by EXIT, 10 were delivered for CLM: seven had polyhydramnios, one had nonimmune hydrops, five delivered preterm, and three were emergency EXITs. The EXIT time and estimated blood loss were 125 minutes (95, 158) and 900 mL (500, 1500), respectively. Airway was secured in all. There was one neonatal death (day 8) with prematurity, sepsis, and pulmonary hypoplasia. Three out of nine were discharged with a tracheostomy. Conclusion: In CLM, close monitoring for structural neck involvement and development of polyhydramnios are important and may be an indication for EXIT as the optimal delivery mode. An experienced multidisciplinary team is a key factor for an effective approach to the obstructed airway in CLM.
AB - Background: The ex utero intrapartum treatment (EXIT) is utilized to transition fetuses with prenatally diagnosed airway obstruction to postnatal life. We describe the unique clinical course, diagnosis, treatment, and outcomes of patients with cervical lymphatic malformation (CLM) managed with EXIT. Methods: Review of fetuses with diagnosed CLM was delivered by EXIT (2001-2018) in a tertiary referral fetal center. Outcomes included survival, tracheostomy at discharge, neonatal course after delivery, and pulmonary hypoplasia. Data are reported as median [range] and rate (%). Results: Out of 45 patients delivered by EXIT, 10 were delivered for CLM: seven had polyhydramnios, one had nonimmune hydrops, five delivered preterm, and three were emergency EXITs. The EXIT time and estimated blood loss were 125 minutes (95, 158) and 900 mL (500, 1500), respectively. Airway was secured in all. There was one neonatal death (day 8) with prematurity, sepsis, and pulmonary hypoplasia. Three out of nine were discharged with a tracheostomy. Conclusion: In CLM, close monitoring for structural neck involvement and development of polyhydramnios are important and may be an indication for EXIT as the optimal delivery mode. An experienced multidisciplinary team is a key factor for an effective approach to the obstructed airway in CLM.
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U2 - 10.1002/pd.5428
DO - 10.1002/pd.5428
M3 - Article
C2 - 30707444
AN - SCOPUS:85063610264
SN - 0197-3851
VL - 39
SP - 287
EP - 292
JO - Prenatal Diagnosis
JF - Prenatal Diagnosis
IS - 4
ER -