Michael D Puricelli1, Reza Rahbar2, Gregory C Allen3, Karthik Balakrishnan4, Matthew T Brigger5, Sam J Daniel6, Pierre Fayoux7, Steven Goudy8, Richard Hewitt9, Wei-Chung Hsu10, Jonathan B Ida11, Romaine Johnson12, Nicolas Leboulanger13, Scott M Rickert14, Soham Roy15, John Russell16, Michael Rutter17, Douglas Sidell4, Marlene Soma18, Briac Thierry13, Marilena Trozzi19, George Zalzal20, Carlton J Zdanski21, Richard J H Smith22. 1. Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. Electronic address: mpuricelli@wisc.edu. 2. Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA. 4. Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University, Stanford, CA, USA. 5. Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA. 6. Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada. 7. Department of Pediatric Otolaryngology Head-Neck Surgery, University Hospital of Lille, Lille, France. 8. Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA. 9. Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. 10. Department of Otolaryngology, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan. 11. Division of Pediatric Otolaryngology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 12. Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA. 13. Pediatric Otolaryngology - Head and Neck Surgery, Necker Enfants Malades Hospital, Paris University, Paris, France. 14. Department of Otolaryngology, NYU Langone, New York, NY, USA. 15. Department of Otorhinolaryngology, University of Texas - Houston, Houston, TX, USA. 16. Department of Paediatric Otolaryngology, Childrens Health Ireland, Crumlin, Ireland. 17. FRACS, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 18. Department of Otolaryngology, Sydney Children's Hospital, Randwick, Australia. 19. Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome (IT), Italy. 20. Department of Otolaryngology, Children's National Health System, Washington, DC, USA. 21. Division of Pediatric Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA. 22. Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Abstract
OBJECTIVE: To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. METHODS: Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. RESULTS: Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. CONCLUSIONS: Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.
OBJECTIVE: To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. METHODS: Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. RESULTS: Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. CONCLUSIONS: Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.
Keywords:
Attended delivery; Congenital high airway obstruction syndrome (CHAOS); Delivery on placental support; Ex utero intrapartum treatment (EXIT); Fetal head and neck mass; Micrognathia; Operation on placental support (OOPS)