Author(s)
Alyssa Calder, MD
Rajanya Petersson, MD, MS, FACS
Sarah Debs, MD
Affiliation(s)
Department of Otolaryngology, Virginia Commonwealth University Medical Center, Richmond VA, USA
Abstract:
Background:
An Ex Utero Intrapartum Treatment (EXIT) procedure allows for the establishment of neonatal cardiopulmonary support during delivery while maintaining uteroplacental circulation. EXIT procedures are recommended in cases where the fetal airway is at risk due to various pathologies such as obstructive masses, conjoined bodies, or underdeveloped upper airway anatomy. Due to the complexity of care, multiple teams are involved in the pre-procedural planning, intraoperative delivery, and postnatal care.
Hypothesis:
It is hypothesized that the extensive planning, meticulous execution, and collaborative nature of EXIT procedures help to improve success and outcomes.
Methods:
A case series of nine EXIT procedures performed involving a multidisciplinary team approach between January 2019 and September 2025 at a single academic center for a variety of neonatal pathologies was reviewed.
Results:
At our institution, EXIT procedures have been performed for two cases involving large oral cavity and neck teratomas, two cases of large cervicofacial lymphatic malformations, an obstructive floor of mouth cyst, a large bilobed maxillary mass, and a neonate found to have a goiter and bilateral cleft lip. The collaborative nature of these EXIT procedures enabled partial delivery in order for our otolaryngology team to perform direct laryngoscopy with intubation, as well as simultaneous needle decompression or immediate mass excision. A case which prompted EXIT procedure planning but resulted in vaginal delivery with subsequent intubation was for a neonate with micrognathia. Another EXIT procedure was planned for concern of laryngeal atresia, resulting in subsequent tracheostomy instead of intubation.
Discussion:
The multidisciplinary team commonly includes otolaryngologists, neonatologists, obstetricians, maternal fetal medicine, anesthesiologists, and operating room staff, all of whom are involved in planning and execution for neonates found to have concerning upper airway pathology on prenatal screening. Overall, the success of EXIT procedures depends heavily on multidisciplinary involvement in prenatal planning, collaborative intraoperative execution, and cohesive postnatal care.