The ex utero intrapartum therapy procedure for high-risk fetal lung lesions.
BACKGROUND
Indications for the ex utero intrapartum therapy (EXIT) procedure have expanded to include any fetal anomaly in which resuscitation of the neonate may be compromised.


METHODS
We reviewed the medical records of 9 patients after resection of lung lesions during the EXIT procedure.


RESULTS
The mean gestational age at EXIT procedure was 35.4 weeks. All lung masses maintained large sizes late into gestation with mean mass volume/head circumference ratio of 2.5 at presentation and 2.2 at EXIT. Seven of 9 fetuses demonstrated hydropic changes (n = 6) and/or polyhydramnios (n = 5), and underwent prenatal intervention including thoracentesis, thoracoamniotic shunt placement, amnioreduction, and/or betamethasone administration. Overall survival after EXIT for lung mass resection was 89%. The average time on placental bypass was 65 minutes. Postnatal complications included reoperation for air leak (n = 1), reoperation for bleeding (n = 1), and death from sepsis and prematurity (n = 1). Venoarterial extracorporeal membrane oxygenation was used in 4 neonates for persistent pulmonary hypertension. Maternal prenatal complications included polyhydramnios (n = 5), preterm labor (n = 4), and chorioamnionitis (n = 1). One mother required perioperative blood transfusion.


CONCLUSIONS
The EXIT procedure allows for controlled resection of large fetal lung lesions at delivery, avoiding acute respiratory decompensation related to mediastinal shift, air trapping, and compression of normal lung.
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. hedrick@email.chop.edu
Holly L
HL
Hedrick
Alan W
AW
Flake
Timothy M
TM
Crombleholme
Lori J
LJ
Howell
Mark P
MP
Johnson
R Douglas
RD
Wilson
N Scott
NS
Adzick
D000293:Adolescent; D000328:Adult; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D004487:Edema; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D020883:Hysterotomy; D008168:Lung / Q000196:embryology*; D008176:Lung Volume Measurements; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013908:Thoracotomy; D016216:Ultrasonography, Prenatal