Subscribe to RSS
DOI: 10.1055/s-0043-117419
Die EXIT-Prozedur – eine Option bei der Erstversorgung von Kindern mit schwerem Hydrops fetalis und beidseitigem Hydrothorax
EXIT – A Possible Intervention for New- and Earlyborn Babies with Severe Hydrops Fetalis and Hydrothoraces on Both SidesPublication History
eingereicht 23 March 2017
akzeptiert 17 July 2017
Publication Date:
15 September 2017 (online)
Zusammenfassung
Die EXIT (ex utero intrapartum treatment)-Prozedur ist ein etabliertes Verfahren der Atemwegssicherung, ursprünglich angewendet bei der Entbindung von Feten mit angeborenen obstruktiven Atemwegserkrankungen (Tumore im Halsbereich, Hygrome, sogenanntes congenital high airway obstruction syndrome (CHAOS)). Mittlerweile wird das Verfahren auch bei ausgeprägten Zwerchfellhernien oder anderen speziellen Indikationen (EXIT to ECMO, kongenitale Lungen-Atemwegsmalformationen (CCAM)), Pulmonalatresie) in großen Perinatalzentren durchgeführt. Wir stellen unsere Erfahrungen mit adaptiertem EXIT-Verfahren bei 5 Frühgeborenen mit sekundär generalisiertem Hydrops fetalis und ausgeprägten beidseitigen Hydrothoraces vor.
Abstract
The EXIT (ex utero intrapartum treatment) procedure is an established method of respiratory protection, originally used in the delivery of fetuses with congenital obstructive airway diseases (tumors in the throat area, hygromas, so-called congenital high airway obstruction syndrome (CHAOS)). Meanwhile, the procedure is also carried out in large perinatal centers for pronounced diaphragmatic hernia or other special indications (EXIT to ECMO, congenital lung airway malformations (CCAM), pulmonary atresia). We present our experience with adapted EXIT procedures in 5 preterm infants with secondary generalized hydrops fetalis and pronounced bilateral hydrothoraces.
-
Literatur
- 1 Longaker MT, Laberge JM, Dansereau J. et al. Primary fetal hydrothorax: natural history and management. J Pediatr Surg 1989; 24: 573-576
- 2 Wy CA, Sajous CH, Loberiza F. et al. Outcome of infants with a diagnosis of hydrops fetalis in the 1990s. Am J Perinatol 1999; 16: 561-567
- 3 Santo S, Mansour S, Thilaganathan B. et al. Prenatal diagnosis of non-immune hydrops fetalis: what do we tell parents?. Prenat Diagn 2011; 31: 186-195
- 4 McCoy MC, Katz VL, Gould N. et al. Non-immune hydrops after 20 weeks´ gestation: review of 10 years´ experience with suggestions for management. Obstet Gynecol 1995; 85: 578-582
- 5 Henry PY, Aravindan CS, Sivakumar K. et al. Extrauterine Intrapartum Treatment (EXIT) in bilateral primary fetal hydrothorax. Indian J Pediatr 2009; 76: 99-101
- 6 Eraslan S, Melekoglu R, Celik E. Extrauterine intrapartum treatment procedure in the unilateral advanced fetal hydrothorax case. Perinatal Journal 2015; 23: 60-64
- 7 Prontera W, Jaeggi ET, Pfizenmaier M. et al. EXIT of severe fetal hydrothorax. Arch Dis Child Fetal Neonatal Ed 2002; 86: F58-F60
- 8 Liechty KW. Ex-utero intrapartum therapy. Semin Fetal Neonatal Med 2010; 15: 34-39
- 9 Catalano PJ, Urken ML, Alcarez M. et al. New approach to the management of airway obstruction in „high risk“ neonates. Arch Otolaryngol Head Neck Surg 1992; 118: 306-309
- 10 Bouchard S, Johnson MP, Flake AW. et al. The EXIT Procedure: Experience and Outcome in 31 Cases. J Pediatr Surg 2002; 37: 418-426
- 11 Marwan A, Crombleholme TM. The EXIT procedure: principles, pitfalls and progress. Semin Pediatr Surg 2006; 15: 107-115
- 12 Taghavi K, Beasley S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. J Paediatr Child Health 2013; 49: E 420-E 427
- 13 Ngamprasertwong P, Vinks AA, Boat A. Update in fetal anesthesia for the ex utero intrapartum treatment (EXIT) procedure. Int Anesthesiol Clin 2012; 50: 26-40