An interventional airway delivery service for congenital high airway obstruction

Abstract

Background: Congenital airway obstruction is rare but potentially fatal. We developed a complex airways interventional delivery team to manage such cases. Antenatal imaging detects airway compromise at an early stage and facilitates the planning of delivery procedures ('ex utero intrapartum treatment' and 'operation on placental support') which maintain feto-placental circulation whilst an airway is secured.

Method: A retrospective review was performed of cases in which ENT input was required at birth for airway obstruction.

Results: Four neonates were delivered before implementation of the service: two were intubated and another two underwent tracheostomy but died in the peri-natal period. Seven neonates were delivered after implementation of the service: six were intubated and one underwent immediate tracheostomy. Five subsequently underwent tracheostomy (three have since been decannulated). One child with multiple congenital anomalies died due to respiratory failure. Airway obstruction was caused by lymphatic malformation, teratoma, costo-craniomandibular syndrome and choristoma.

Conclusion: In the absence of other anomalies, interventional airway delivery led to reduced mortality and improved outcomes.

Keywords: Airway Obstruction; Caesarean section; Obstetrics; Otolaryngology; Perinatal Care; Polyhydramnios.