Predicting the Difficult Neonatal Airway in Fetuses With Micrognathia, Oropharyngeal or Neck Mass Lesions: Two-Center Experience With Fetal MRI.

IF 2.7 2区 医学 Q2 GENETICS & HEREDITY Prenatal Diagnosis Pub Date : 2024-12-01 Epub Date: 2024-09-24 DOI:10.1002/pd.6651
Stacy Goergen, James Christie, Tracy Jackson, Maria-Elisabeth Smet, Simon Robertson, Atul Malhotra, Annie Kroushev, Mark Lovell
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Abstract

Objective: Neonatal airway compromise requiring intubation, due to micrognathia or a mass lesion obstructing the fetal airway, remains difficult but important to predict prenatally. We aimed to validate MR predictors of difficult neonatal airway (DNA) in a multicentre retrospective cohort of fetuses with micrognathia and oropharyngeal/neck masses.

Method: The radiology databases of two large Australian maternal-fetal medicine centers were searched for subjects meeting inclusion criteria: Pregnancies of > 18 weeks' gestation evaluated with prenatal ultrasound and MRI between 2007 and 2022 where either fetal micrognathia or a fetal cervical, oral or oropharyngeal mass was identified on prenatal ultrasound and MRI, and details of delivery/postnatal course were available including: nature of delivery, need for the fetal airway to be secured at delivery, degree of difficulty in airway securement, survival > 24 h postnatally. Imaging predictors of a difficult neonatal airway (DNA) were assessed blinded to these neonatal outcomes.

Results: Twenty-six fetuses met the inclusion criteria. Oropharyngeal and neck mass location with polyhydramnios was 100% sensitive and 82% specific for DNA. JI < 5th centile with polyhydramnios was 83% sensitive and 70% specific. JI < 5th centile with polyhydramnios was associated with DNA in 80% of cases delivered by ex utero intrapartum (EXIT) delivery and none with non-EXIT delivery mode.

Conclusion: A cervical or oropharyngeal mass with polyhydramnios predicted a difficult neonatal airway. Polyhydramnios with jaw index < 5th centile was less sensitive and less specific for a difficult neonatal airway.

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预测有小颌畸形、口咽或颈部肿块病变的胎儿新生儿气道困难:使用胎儿核磁共振成像的双中心经验。
目的:由于小颌畸形或肿块病变阻塞胎儿气道,新生儿气道受损需要插管,这仍然是产前预测的难点,但却非常重要。我们的目的是在小颌畸形和口咽/颈部肿块胎儿的多中心回顾性队列中验证新生儿气道困难(DNA)的磁共振预测指标:搜索澳大利亚两家大型母胎医学中心的放射学数据库,寻找符合纳入标准的受试者:2007年至2022年期间,妊娠大于18周的孕妇通过产前超声和核磁共振成像进行评估,产前超声和核磁共振成像发现胎儿小颌畸形或胎儿宫颈、口腔或口咽部肿块,并提供分娩/产后过程的详细信息,包括:分娩性质、分娩时胎儿气道是否需要固定、气道固定的困难程度、产后存活大于24小时。对新生儿气道困难(DNA)的影像预测进行了评估,并对这些新生儿结果进行了盲法处理:26名胎儿符合纳入标准。口咽和颈部肿块位置与多胎妊娠对 DNA 的敏感性为 100%,特异性为 82%。JI 结论:颈部或口咽部肿块合并多胎妊娠预示新生儿气道困难。多胎妊娠合并颌骨指数小于第 5 百分位数对新生儿呼吸道困难的敏感性和特异性较低。
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来源期刊
Prenatal Diagnosis
Prenatal Diagnosis 医学-妇产科学
CiteScore
5.80
自引率
13.30%
发文量
204
审稿时长
2 months
期刊介绍: Prenatal Diagnosis welcomes submissions in all aspects of prenatal diagnosis with a particular focus on areas in which molecular biology and genetics interface with prenatal care and therapy, encompassing: all aspects of fetal imaging, including sonography and magnetic resonance imaging; prenatal cytogenetics, including molecular studies and array CGH; prenatal screening studies; fetal cells and cell-free nucleic acids in maternal blood and other fluids; preimplantation genetic diagnosis (PGD); prenatal diagnosis of single gene disorders, including metabolic disorders; fetal therapy; fetal and placental development and pathology; development and evaluation of laboratory services for prenatal diagnosis; psychosocial, legal, ethical and economic aspects of prenatal diagnosis; prenatal genetic counseling
期刊最新文献
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