At Riley Children’s Health, highly skilled specialists perform an EXIT procedure when a baby’s health is at risk.
What is an EXIT procedure?
What is an EXIT procedure?
Ex utero intrapartum treatment (EXIT) procedure is a highly specialized surgical procedure performed during childbirth. It is designed to ensure the safety of both the mother and the baby when the baby has a condition that could obstruct the airway or require immediate medical intervention after delivery. The procedure allows the medical team to secure the baby's airway and perform other procedures or surgeries as needed while the baby is still receiving oxygen through the placenta.
Indications for EXIT
EXIT is typically indicated for babies diagnosed with conditions that could compromise their airway or breathing at birth. These conditions include:
- Congenital high airway obstruction syndrome (CHAOS): A rare condition where the baby's airway is blocked.
- Large neck masses: Such as cervical teratomas or lymphatic malformations that can obstruct the airway.
- Severe micrognathia: A condition where the jaw is significantly smaller than normal, which can cause airway obstruction.
- Large lung or heart masses: Some lung or heart masses can push on the heart and normal lungs, preventing normal cardiopulmonary function after birth.
What to Expect
What to Expect
Preparation
The procedure is meticulously planned with a multidisciplinary team, including maternal-fetal medicine, ENT, pediatric surgeons, anesthesiologists, and neonatologists. Detailed imaging studies, such as ultrasounds and MRIs, are conducted to assess the baby's condition and plan the procedure.
Delivery
EXIT procedure is performed during a cesarean section. The mother is given anesthesia, and an incision is made in the abdomen and uterus. The baby is partially delivered, with the lower body remaining in the uterus. This allows the baby to continue receiving oxygen through the placenta while the medical team works to secure the airway or do other necessary procedures.
Airway management
While the baby is still connected to the placenta, the medical team secures the baby's airway. This can involve:
- Intubation: Inserting a tube into the baby's trachea to ensure an open airway.
- Tracheostomy: Creating an opening in the baby's neck to insert a tube directly into the trachea if intubation is not possible.
- EXIT to resection and EXIT to ECMO: Some babies benefit from being placed on a heart and lung bypass system (ECMO) until the airway is under better control or the obstructing mass is removed.
Completion
Once the airway is secured and the baby is stable, the baby is fully delivered and can be transitioned to neonatal care. The umbilical cord is clamped and cut, and the baby is taken to an adjacent operating room (OR) for stabilization. The baby will then be taken to the neonatal intensive care unit (NICU) for further management.
Benefits of EXIT procedure
Benefits of EXIT procedure
- Safety: EXIT procedure provides a controlled environment to secure the baby's airway, reducing the risk of hypoxia (lack of oxygen) and other complications.
- Immediate Care: The procedure allows for immediate medical intervention for conditions that could be life-threatening if not addressed promptly.
- Multidisciplinary approach: EXIT procedure involves a team of specialists, ensuring comprehensive care for both mother and baby.
Risks and Considerations
Risks and Considerations
- Surgical risks: As with any surgical procedure, there are risks, such as bleeding, infection, and complications from anesthesia. The mother may also experience complications related to the cesarean section.
- Maternal health: The procedure requires a cesarean section, which has its own set of risks and a longer recovery time compared to vaginal delivery. The mother will need to recover from the surgery and may require additional support.
- Neonatal outcomes: The success of the procedure depends on the underlying condition and the baby's overall health. Some babies may require additional surgeries or long-term medical care.
After the Procedure
After the Procedure
Neonatal care
After the EXIT procedure, the baby will receive specialized care in a NICU. The medical team will monitor the baby's condition and provide any necessary treatments.
Recovery
The mother will recover from the cesarean section with support from the medical team. Pain management, wound care, and monitoring for any complications are important aspects of the recovery process.
Follow-Up
Regular follow-up appointments are essential to monitor the health and development of the baby and the recovery of the mother. These appointments allow the healthcare team to address any ongoing medical needs and provide support to the family.
Key Points to Remember
- Ex utero intrapartum treatment (EXIT) procedure is a highly specialized surgical procedure performed during childbirth.
- It is designed to ensure the safety of both the mother and the baby when the baby has a condition that could obstruct the airway or require immediate medical intervention after delivery.
- The procedure is meticulously planned with a multidisciplinary team, including maternal-fetal medicine, ENT, pediatric surgeons, anesthesiologists, and neonatologists.
- Once the airway is secured and the baby is stable, the baby is fully delivered and can be transitioned to neonatal care.
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