COLUMBUS, Ohio – During a rare delivery in an operating room at The Ohio State University Medical Center, specialists recently treated an infant while still attached to the umbilical cord, to guard against a large cyst pressing on the baby’s airway.
The OSU Medical Center is one of few facilities in the nation offering the procedure, known as EXIT (Ex-Utero Intrapartum Treatment).
With the help of ultrasound and magnetic resonance imaging, Dr. Richard O’Shaughnessy, director of the Fetal Treatment Program at OSU Medical Center, can detect conditions such as a growing mass on the neck or lungs of a developing baby, which can push the airway out of alignment, or perhaps a large tumor or cyst that can interfere with the ability of a baby to breathe immediately after birth.
“In a case requiring the EXIT procedure, it would be dangerous for the baby to cut the umbilical cord, which serves as its own lifeline,” says O’Shaughnessy, maternal-fetal medicine specialist. “We want to maintain the baby’s attachment to the mother, until we’re certain that the baby can receive oxygen through an unobstructed airway.”
During EXIT, surgical teams are present in the delivery room, in preparation for any potential complication of the mother or baby. The mother is placed under general anesthesia, so her uterus can relax and the baby can receive anesthesia through the umbilical cord. The maternal-fetal medicine specialist delivers the baby partially, by cesarean section, so that only the baby’s head, neck and one arm are delivered while the remainder of the infant’s body is left inside the uterus.
The baby continues to receive life-sustaining oxygen and blood from the placenta during the procedure. Infants can remain attached to the umbilical cord for approximately one hour, until the placenta starts to lose its ability to provide oxygen and nutrients from the mother.
In the recent case at OSU, the infant remained on the mother’s pelvis so that Dr. Gregory Wiet, pediatric otolaryngologist, could have the time he needed to place a breathing tube into the airway, giving the baby the ability to breathe.
To accomplish this, he used a camera to visualize the airway for placement of the breathing tube. The baby’s heart rate and oxygen were monitored continuously. The delivery was then completed, and the stabilized baby was taken to the hospital’s nursery.
Within a matter of hours, the infant was transported to Nationwide Children’s Hospital, where her cyst was drained and treated, and the healthy newborn recently went home.
The EXIT procedure requires a team effort from many OSU Medical Center specialties, including maternal-fetal medicine, pediatric otolaryngology, neonatology, obstetric anesthesiology, and labor and delivery nursing, all together in the main operating room.
“In addition to the internal collaboration, our partnership with Nationwide Children’s Hospital ensures the best in care for mothers and their newborn babies,” says O’Shaughnessy.
“We hope to work together on a growing number of cases, as more patients are identified who can benefit from the EXIT procedure,” says Dr. Gregory Wiet, otolaryngologist, Nationwide Children’s Hospital and associate professor, otolaryngology at OSU Medical Center.