title: Perinatal airway management of neonatal cervical teratomas.
abstract: Cervical teratomas are rare but life-threatening neonatal tumors and management of the fetus with a cervical teratoma that threatens the airway remains a clinical challenge. This has been revolutionized by advances in fetal imaging and management of the airway at delivery including the use of Ex-utero Intrapartum Treatments (EXIT procedures). We present a retrospective case series of three neonates managed over a 12-month period. Following pre-natal fetal MRI and a multi-disciplinary management approach, two newborns were managed by prompt post-natal endotracheal intubation while an EXIT procedure was required in one. All three underwent surgical resection in the first few days of life. A decision regarding the best means by which to manage the airway in fetal cervical teratoma requires fetal MRI and a multi-disciplinary team approach to determine whether EXIT, or a safer approach from a maternal perspective can be employed. We also recommend routine endotracheal intubation at birth, due to the risk of spontaneous intra-tumoral hemorrhage. The need for surgery should be planned early, as rapid growth of the tumor can threaten the viability of the overlying skin and surrounding structures.
authors.affiliation: Royal Children's Hospital, Flemington Road, Parkville 3052, Melbourne, Australia.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Taghavi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Berkowitz
authors.forename: A Michelle
authors.initials: AM
authors.lastname: Fink
authors.forename: Ross D
authors.initials: RD
authors.lastname: Farhadieh
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Penington
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D005260:Female; D046128:Fetal Therapies; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D012189:Retrospective Studies; D013724:Teratoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult