2024 Volume 60 Issue 5 Pages 788-796
Purpose: In this study, we aimed to improve the survival rate of neonates with severe upper airway closure disease by evaluating the current situation of neonates with difficult or predicted difficult airway management immediately after birth and proposing perinatal management and future treatment strategies.
Method: This study included five infants who required pediatric surgical intervention owing to airway problems shortly after birth out of 2,909 infants born at Iwate Medical University Hospital from September 2014 to September 2023. The medical records of these infants were reviewed retrospectively, considering factors such as prenatal imaging diagnosis, perinatal course, immediate postnatal treatment, and outcomes.
Results: The subjects were five infants, among whom four were considered for ex utero intrapartum treatment (EXIT) on the basis of fetal diagnosis. EXIT was used for fetal diagnosis in three cases. EXIT was effective for laryngeal atresia. Survival was challenging in cases of tracheal agenesis even with EXIT. An infant with cervical lymphangioma later died from an underlying disease. One infant was born unexpectedly and could not be saved even with emergency airway management. In some cases, prenatal preparations can save lives. Long-term survivors require specialized treatment and gradual rehabilitation to regain swallowing and vocalization, even when their respiratory function stabilizes.
Conclusions: Immediate postnatal airway management poses challenges, necessitating multidisciplinary treatment and thorough preparation to increase survival rates. Centralizing perinatal medical care in each region and bolstering the system are crucial steps towards this goal.
