Healthy Outlook Blog

EXIT Procedure Saves Newborn Lives

By Melba Newsome | Posted November 3 2010

Health Information, prenatal care, Research, Technology, Women's Health

Shortly after her 20 week ultrasound, Angela Dundon’s abdomen began to grow at such an alarming rate that she was measuring three weeks farther along in her pregnancy than she was. Angela and her husband, Mike, were referred to the Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia. An extensive one-day evaluation determined that their baby girl had a fast-growing, non-cancerous mass the size of a football crushing her throat and blocking her airway. The obstruction prevented the baby from swallowing the amniotic fluid, causing Angela’s uterus to swell excessively.

Detecting prenatal birth defects has allowed physicians to provide better perinatal care. However, in some cases, the babies were too sick to be treated successfully after delivery. As diagnosis and techniques improve, the range of conditions for which fetal surgery can be used has expanded. The Ex Utero Intrapartum Therapy (EXIT) procedure is an innovative fetal surgical technique that proved crucial to saving the life of the Dondons’ baby.

A fetal EXIT is a combination of a traditional Cesarean section delivery and an operation performed on the baby at delivery to correct a problem, which would otherwise mean near-certain death. During the EXIT, the newborn remains attached to the mother to receive oxygen via the umbilical cord and placenta. Without this procedure, doctors have a very narrow window to access an airway before the baby dies or suffers severe brain damage.

“Ordinarily, you would have about four minutes to get the breathing tube in place,” says Lori J. Howell, RN, MS, Executive director, Center for Fetal Diagnosis and Treatment. “Because the baby is hooked to the umbilical cord, the EXIT gives us 45 minutes to an hour to find and establish an airway and put a breathing tube in place.”

During the four-hour procedure, the surgeon removed the baby’s head and neck from the uterus and discovered that the 1.5 pound tumor had displaced her esophagus so dramatically, it was now located near her right ear. The surgeon then secured the airway and removed the tumor before cutting the umbilical cord. The procedure went off without a hitch and Baby Ava was delivered weighing 6 pounds, 3 ounces.

Howell says CHOP has performed about 86 EXIT procedures since 1996, probably more than any hospital in the world. “I was there for the first EXIT. But every time I witness one, I’m amazed. It’s a highly choreographed dance with the medical, surgical, anesthesiological and nursing teams working in concert to saves these babies who would otherwise be doomed.”

CONNECT THE DOTS

Learn more about the EXIT and its applications, as well as all types of fetal surgeries. Children’s Hospital of Philadelphia has links to publications about the EXIT procedure.

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