Chennai: A team of doctors performed rare surgery to save the life of a baby who had developed goitre while still in the mother's womb. The child was successfully delivered using EX-utero Intrapartum Treatment (EXIT) and child and the mother are healthy now.
The ultrasound report of S. Divya (name changed), during the 28th week of pregnancy revealed a swelling on front of the neck of her baby possibly from the thyroid gland. This swelling was large, restricted the baby's swallowing causing pressure effect on the neck of the developing baby and resulted in increase of the fluid around the baby.
During 36th week, a fetal MRI was done which showed compression of the trachea (airway), which would make it difficult for the baby to breathe if it was delivered. Anticipating problems in securing airway an EXIT procedure was planned at Dr Mehta's Hospitals.
“EXIT is a procedure that is used to deliver babies with a neck swelling or wherever a difficult airway is anticipated due to a mass in the neck or upper chest. The procedure preserves utero-placental gas exchange i.e. baby continues to receive oxygen and nutrients from the mother until an airway is established by placing an endotracheal tube and lung ventilated with satisfactory oxygenation,” said neonatal specialist Dr Lakshmi.
A caesarean section was performed under general anesthesia, the baby was delivered only up to the head and held in position with the body still in the uterus with intact umbilical cord.
“An attempt to intubate the airway with a tube to make an air passage for breathing was made. As we were not able to visualize vocal cords, under bronchoscopic guidance the team secured airway, after the airway was secured, the baby was delivered and then the cord was cut,” added Dr Lakshmi.
In the meanwhile baby's blood drawn for thyroid function tests and oral thyroid hormone replacement was started. With that the swollen gland started shrinking well, the baby was taken off the endotracheal tube and ventilation on day three. The child was able to breath easily without difficulty and is recovering well.
