International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

doi:10.1016/j.ijporl.2020.110281

International Journal of Pediatric Otorhinolaryngology

Volume 138, November 2020, 110281

https://doi.org/10.1016/j.ijporl.2020.110281 Get rights and content

Abstract

Objective

To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery.

Methods

Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. “Consensus” was defined by >80% respondent affirmative responses, “agreement” by 51–80% affirmative responses, and “no agreement” by 50% or less affirmative responses.

Results

Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure.

Conclusions

Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

Section snippets

Consensus objective

To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery.

Target population

All pregnancies with concern for neonatal airway obstruction.

Intended users

These consensus recommendations are intended to inform:

1.
Otolaryngologists who provide prenatal consultation for anticipated airway obstruction and perinatal airway treatment.
2.
Medical professionals including, but not limited to, maternal fetal medicine specialists, neonatal intensive care unit specialists, anesthesiologists, and others who collaborate in the care of these patients.

Methods

Consensus guidelines are based upon expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was used to establish recommendations on the prenatal and perinatal management of anticipated neonatal airway obstruction. An online survey was designed by two authors (MP and RS). The survey was distributed to all members of the IPOG and responses recorded. Twenty-seven responses were received from experts in eight countries. The

Disclaimer

This report has been prepared by the members of the International Pediatric Otolaryngology Group (IPOG). Consensus recommendations are based on the collective opinion of the members of the group. Any person seeking to apply or consult the report is expected to use independent medical judgment in the context of individual patient and institutional circumstances.

Recommendations and justification

Section 1
: Etiologies of perinatal airway obstruction
Section 2: Imaging evaluation
Section 3: Adjunct evaluation
Section 4: Multidisciplinary team and decision factors
Section 5: Micrognathia management
Section 6: CHAOS management
Section 7: Head and neck mass management
Section 8: Attended delivery procedure
Section 9: Delivery on placental support procedure

Conclusion

Conditions potentially causing neonatal airway obstruction present substantial morbidity and mortality risk. Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

Declaration of competing interest

The authors have no relevant conflicts of interest.

Acknowledgements

Drs. Richard Smith (senior author) and Michael Puricelli (first author) were the lead authors. Dr. Reza Rahbar provided primary consulting and guidance regarding the design of the consensus recommendations. All remaining authors are listed in alphabetical order. All authors have contributed to the conception and design of the work, drafting and revising the consensus recommendations for important intellectual content, final approval of the version to be published, and agreement to be

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La relajación uterina máxima y controlada para maximizar la perfusión placentaria y fetal, manteniendo el bienestar fetal y materno, son los paradigmas de cualquier tipo de EXIT. El aspecto más importante de una intervención en soporte placentario es consolidar un equipo multidisciplinario altamente capacitado, bien coordinado y preparado para cualquier contingencia. Una evaluación prenatal completa, incluyendo ultrasonido, ecocardiografía fetal, resonancia magnética y pruebas genéticas, es imprescindible para la selección de pacientes. La planificación preoperatoria exhaustiva, las reuniones de equipo ad-hoc y las simulaciones quirúrgicas para casos desafiantes son estrategias críticas para lograr los mejores resultados clínicos.
El presente artículo describe el algoritmo de estudio prenatal, la planificación preoperatoria, los aspectos técnicos, los principios básicos y los fundamentos del procedimiento EXIT.
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Citation Excerpt :
Furthermore, it is important to note that the full spectrum of the aforementioned features might not be met in all cases, and it is not required to warrant additional work-up.8 Scanning for additional malformations (present in approximately 50%) is mandatory for counseling.8 The most frequent associated genetic condition is Fraser syndrome, which is an autosomal recessive disorder characterized by tracheal or laryngeal atresia, cryptophthalmos, bilateral renal agenesis, urogenital tracts anomalies and syndactyly or polydactyly.46
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International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Consensus objective

Target population

Intended users

Methods

Disclaimer

Recommendations and justification

Conclusion

Declaration of competing interest

Acknowledgements

Semin. Pediatr. Surg.

Clin. Perinatol.

Int. J. Pediatr. Otorhinolaryngol.

Clin. Perinatol.

Obstet. Gynecol.

Int. J. Pediatr. Otorhinolaryngol.

Semin. Pediatr. Surg.

J. Pediatr. Surg.

Int. J. Oral Maxillofac. Surg.

J. Pediatr. Surg.

Int. J. Pediatr. Otorhinolaryngol.

J. Pediatr. Surg.

Semin. Fetal Neonatal Med.

Obstet. Gynecol.

J. Pediatr. Surg.

J. Pediatr. Surg.

J. Pediatr. Surg.

J. Pediatr. Surg.

J. Pediatr. Surg.

Int. J. Pediatr. Otorhinolaryngol.

Am. J. Obstet. Gynecol.

J. Pediatr. Surg.

Best Pract. Res. Clin. Obstet. Gynaecol.

J. Pediatr. Surg.

J. Pediatr. Surg.

J. Pediatr. Surg.

Otolaryngol. Head Neck Surg.

Int. J. Obstet. Anesth.

Int. J. Pediatr. Otorhinolaryngol.

Fetal airway management on placental support: limitations and ethical considerations in seven cases

J. Obstet. Gynaecol.

Micrognathia. Am J Obstet Gynecol

Transmission of the dysgnathia complex from mother to daughter

Am. J. Med. Genet.

Fetal micrognathia: almost always an ominous finding

Ultrasound Obstet. Gynecol.

Predictive factors for perinatal outcomes of infants diagnosed with micrognathia antenatally

Ear Nose Throat J.

Determining risk factors for early airway intervention in newborns with micrognathia

Laryngoscope

Airway management of neonates with antenatally detected head and neck anomalies

Arch. Otolaryngol. Head Neck Surg.