C. C. Style3, S. M. Cruz3, O. O. Olutoye2,3,5, P. Lau3, D. A. Lazar3,5, T. C. Lee3,5, R. Ruano2,6, S. E. Welty4,6, S. Keswani3,5, D. L. Cass3,5 1Texas Children’s Hospital,Micheal E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Obstetrics And Gynecology,Houston, TX, USA 3Baylor College Of Medicine,Micheal E. DeBakey Department Of Surgery,Houston, TX, USA 4Texas Children’s Hospital,Pediatrics – Newborn Section,Houston, TX, USA 5Texas Children’s Hospital,Fetal Center,Houston, TX, USA 6Baylor College Of Medicine,Houston, TX, USA
Introduction:
Fetal neck masses encompass an array of rare congenital malformations that can have potentially devastating consequences in the perinatal period. Prenatal MRI and calculation of the tracheoesophageal displacement index (TEDI) helps to risk-stratify fetuses at risk for airway obstruction and those who may most benefit from an ex-utero intrapartum treatment (EXIT) at delivery. Other postnatal complications experienced by these infants include respiratory failure, feeding problems, cosmetic disfigurement, and persistent disease. The purpose of this study is to evaluate the association between prenatal features and postnatal outcomes, and indications for an EXIT procedure in this population.
Methods:
A single center retrospective review was performed on all fetuses referred to our institution from July 2001 to January 2016 with a prenatal ultrasound diagnosis of neck mass. Imaging features, fetal diagnosis, treatment modality, and fetal and postnatal outcomes were evaluated. At birth, each infant’s airway was classified as uncomplicated or complicated. Fetal diagnosis was compared to postnatal diagnosis as confirmed by surgical and pathological findings
Results:
Of 47 fetuses identified, 3 had pregnancy termination; 5 had fetal demise. Fetal diagnostic accuracy was 97%; 1 case of thymic cyst was not accurately diagnosed antenatally. Prenatal findings of a teratoma diagnosis (9/10), polyhydramnios (61% vs 33%), small stomach bubble (52% vs 0%), mass size (10 [4-15] vs 7 [2-20]), and TEDI >12 all correlated with a difficult airway at birth. EXIT procedures, performed for 20 fetuses with teratoma or large lymphatic malformation (see table), were associated with similar outcomes with regard to survival (77% vs 81% respectively, p=0.54) and long term pulmonary morbidity compared to those not requiring EXIT. With multivariate regression analysis, location of the mass (anterior or posterior), presence of polyhydramnios, and mass size as per fetal MRI were independent prenatal predictors of survival at 6 months (p=0.001).
Conclusion:
Fetuses diagnosed prenatally with neck mass that are at a high risk for difficult airway can be safely delivered via an EXIT. They have a similar rate of survival and morbidity as those fetuses of lower risk who did not require an EXIT. These findings can help aid in the prenatal counseling of these patients.
