title: Tracheoesophageal displacement index and predictors of airway obstruction for fetuses with neck masses.
abstract: OBJECTIVE
  There are no established selection guidelines to determine which fetuses with giant neck masses may benefit from delivery using an ex utero intrapartum treatment procedure. The purposes of this study were to describe the tracheoesophageal displacement index (TEDI), a novel measurement of fetal airway displacement, and to correlate this measurement and other prenatal findings to the extent of airway obstruction at birth.
  
  
  METHODS
  The medical records of all fetuses with giant neck masses evaluated between 2001 and 2011 were reviewed. At birth, each infant's airway was categorized as uncomplicated or complicated. Prenatal variables were correlated with airway difficulty.
  
  
  RESULTS
  There were 24 fetuses with large neck masses (11 lymphatic malformations, 10 teratomas, 3 others). One fetus died in utero, and 3 underwent pregnancy termination. Variables associated with a complicated airway at birth included polyhydramnios, teratoma diagnosis, and tracheoesophageal displacement index. Tracheoesophageal displacement index greater than 12 correlated strongly with a complicated airway (area under the curve = 0.80). All fetuses classified with an uncomplicated airway (n = 7) had a diagnosis other than teratoma and normal amniotic fluid volume.
  
  
  CONCLUSIONS
  In fetuses with giant neck masses, the presence of polyhydramnios, teratoma diagnosis, or tracheoesophageal displacement index greater than 12 are predictive of a complicated airway at birth. Our data suggest that fetuses without any of these findings may be delivered safely without an ex utero intrapartum treatment approach.
authors.affiliation: Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lazar
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Cassady
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009333:Neck / Q000002:abnormalities*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology*; D055815:Young Adult