title: Emergent airway management in the labor and delivery suite.
abstract: BACKGROUND
  Congenital airway obstruction is of varied etiology and uncommonly encountered. Prenatal care and imaging have enhanced detection of these abnormalities and allow for multi-disciplinary care planning for airway management at delivery. Despite the availability and advances in prenatal imaging, unanticipated airway obstruction may not be identified until the time of delivery.
  
  
  METHODS
  Case series.
  
  
  RESULTS
  Four airway emergencies were encountered in the labor and delivery suite over an eight-month period. Clinical history is correlated with autopsy findings. Congenital upper airway and laryngotracheal anomalies are reviewed. Recommendations to improve timely and efficient airway management in the labor and delivery suite are discussed and a protocol for a multi-disciplinary neonatal emergency airway response team is offered for consideration.
  
  
  CONCLUSIONS
  The development and implementation of a multi-disciplinary emergency newborn airway protocol is both realistic and feasible. While it did not improve survivability in our small group, it did reduce response time. It, or a protocol like it, is recommended for institutions caring for high-risk pregnancies and with Neonatal Intensive Care Units with high acuity patients.
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, OH, USA. Electronic address: brysonp@ccf.org.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Bryson
authors.affiliation: The North Carolina Children's Airway Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Abode
authors.affiliation: The North Carolina Children's Airway Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Zdanski
mesh_terms: D058109:Airway Management; D000402:Airway Obstruction / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy*; D036861:Delivery, Obstetric; D004630:Emergencies; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy
keywords: Congenital airway abnormalities; Neonatal airway; Pediatric airway management