Dr. Prashant Jain
BLK Centre of Neonatal,
Paediatric & Adolescent
BLK Super Speciality
Hospital, New Delhi
A life saved by performing a challenging Exit
A new born baby with a large neck mass blocking his airways was
able to have a safe access and new lease of life owning to a rare and
diffi cult procedure called Extra Uterine Intra Partum Treatment
(EXIT) performed by the Paediatric Surgery and Neonatology team of
BLK Super Speciality Hospital.
A 29-year old lady, 30 weeks pregnant from Bihar was diagnosed on
antenatal ultrasound scan to have a large neck mass in foetus. The
patient was referred to BLK Super Speciality Hospital for further
management. The patient was further evaluated and a foetal MRI was
done which was suggestive of large neck mass of an approximate size
of 10 x 9 cm. The infant’s airways could not be visualized as the giant
cervical mass was compressing it.
The infant’s normal exit from the womb would have been life
threatening as the wind pipe was blocked due to the giant neck mass,
obstructing the oxygen passage despite its abundant presence. The
odds were stacked against his survival, as his wind pipe had to be
decongested by intubation while he was still in the uterus, keeping the
umbilical circulation intact throughout the intervention.
A multidisciplinary team comprising Paediatricians, Neonatologists,
Paediatric Anaesthesiologists, Obstetricians, Paediatric Cardiologist,
Paediatric Pulmonologist, Paediatric ENT specialists and dedicated
nursing staff and other operating room personnel was formed to
perform this rare and critical procedure.
A special caesarean section was performed, only the head and
shoulder of baby were delivered out of uterus and intubation was done.
Intubation procedure was swiftly done within a record time of 1
minute 32 seconds. Every step during the caesarean and after delivery
operation of Giant Cervical Lymphangioma was performed with
precision and the end result was quite satisfying as the baby was
breathing safely. The case also required a special C-section to keep
the foeto-placental circulation intact. This can only be made possible
under general anaesthesia with uterine relaxants. But again this
carries a high risk of maternal bleeding. After the successful windpipe
procedure and delivery of the new born, the non-cancerous Tumour in
the neck was also operated. Intubation was also done away with as his
windpipe was decongested thoroughly.
The baby and mother were well post operation and recuperated without
any complication. The mother and baby duo got discharged after a few
When the baby is in womb, mother breathes for him through the
umbilical cord. But once out of the womb, the baby needs to breathe for
himself as all babies do. It would have been fatal for the baby had he
exited without going through the ‘EXIT’ procedure. Securing airway
after the child is delivered could have been diffi cult because of distorted
anatomy of neck and the intubation time cannot exceed more than 25-
30 seconds to prevent brain hypoxia. So EXIT procedure was the only
option left with the doctors wherein they could have comparatively
more time to perform the intubation procedure.