A Five-year Experience of EXIT Procedure in East Coast of Malaysia: A Literature Review with Cases

Abstract

Introduction: With the advancement of the prenatal assessment and early diagnosis of foetal head and neck lesions in utero that potentially causing upper airway obstruction in neonates, Ex Utero Intrapartum Treatment (EXIT) procedure has becoming an accepted, updated medical intervention worldwide to manage such cases. This method has led to a significant change in neonatal management and improved neonatal outcomes. The objective of this study was to describe and evaluate the 5-year experience with EXIT procedure in the year 2014 till 2019 at the East Coast region in Malaysia from the paediatric ENT perspective. 

Method:  All EXIT procedures performed in 2 hospitals in East Coast region of Peninsular Malaysia, which are Hospital Raja Perempuan Zainab II and Hospital Sultanah Nur Zahirah between 2014 and 2019 were retrospectively reviewed. We study EXIT Procedures performed during that period, focusing on the prenatal assessment, pre-operative planning, intraoperative and post-operative management of the cases. We also analysed the postoperative outcome of the patients.

Results: EXIT procedures were performed in five cases with prenatal diagnosis of cystic hygroma in three cases, one case of epulis and one case of Congenital High Airway Obstruction Syndrome (CHAOS). Airway management was successful with endotracheal intubation in 4 cases (three cases of cystic hygroma and one case of epulis) and failed in the CHAOS case. The CHAOS case underwent tracheostomy after bronchoscopy but succumbed to the disease. Long term survival was achieved with the four successful EXIT cases.

Conclusion: Results from our series of EXIT procedure was effective and can be performed safely in the airway management of foetuses suspected airway obstruction. Early referral and multidisciplinary teams involvement and planning were very crucial for a planned delivery and should be done earlier before birth.