Intubation of newborn during delivery with intact umbilical cord--a case report.
A 24-year-old gravida 2, para 1 woman at 38th week gestation was scheduled for elective Cesarean section (C/S) because of a previous C/S and prenatal diagnosis of congenital diaphragmatic hernia. We decided to intubate the newborn during delivery before the umbilical cord was cut. After delivery of the fetal head and part of the shoulders, the mouth of the fetus was cleared and the trachea was intubated orally with a 2.5 mm internal diameter (I.D.) endotracheal tube under sterile conditions while the uteroplacental circulation was still intact. The patient had to be repeatedly resuscitated due to bradycardia in intensive care unit. No surgical correction of the hernia was attempted because of the poor condition of the baby, which died 3.5 hours after birth. Although our case ended up in mortality despite successful perinatal intubation, we recommend that in case where airway or ventilatory problems are anticipated, tracheal intubation is done during delivery before the umbilical cord is clamped. When the fetus is sharing the maternal circulation, it will allow physicians to have more time and safety to perform corrective measures.
Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taipei, Taiwan, R.O.C.
C J
CJ
Huang
B
B
Jawan
Y Y
YY
Poon
J H
JH
Lee
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D011247:Pregnancy