Tracheal Atresia

[spartacus007]

Dear Colleagues

How would you manage tracheal atresia in your set up if diagnosed antenatally

Alok

[Stefan Johansson]

I was not involved myself in a case some few years ago but as I understood:

1) prenatal assessment of the tracheal gap (MRI)

2) elective CS with ENT team doing tracheostomy while the baby was on the placental circulation

[moroz]

All efforts to investigate gap 

Try to stratify case based on Waterstone classification, old, but useful , allowing define strategy of management and to some degree prognosis 

Based on these data make suggestion on surgical strategy (radical corection, Foker, Kimura...) 

And follow your plan, keeping close interaction with surgeons etc, - multidisciplinary approach

 

 

 

 

 

 

 

 

 

 

[yinghua]

I totally agree with Stefan. Since the diagnosis has been made, you have to send the mother to regional center where the EXIT- Ex-Utero Intrapartum Treatment can be performed.

Best regards

Yinghua Li 

[Shazia]

Agree with Stefan - antenatal counselling by obstetrician neonatologist and ENT consultants  to ensure family are fully aware and in agreement with plan; MRI to look at gap and also assess for other anomalies; extensive multi-team planning to ensure everything is available for the ENT team (kit and staff). Ensure that all teams are sufficiently prepped and staffed on the day, and that the delivery is early in the day shift (just makes it easier to have it planned that way). We have also set up an adjacent theatre to ensure ENT can proceed with surgery if required/appropriate immediately.

[Katja]

On 7/27/2022 at 11:14 PM, Stefan Johansson said:

I was not involved myself in a case some few years ago but as I understood:

1) prenatal assessment of the tracheal gap (MRI)

2) elective CS with ENT team doing tracheostomy while the baby was on the placental circulation

I would totally agree, assment of the  gap and if possible tracheostomy under EXIT procedure.

Often it is not possible, because of the distal end of the trachea. 

[Nathan Sundgren]

Not adding much here, but EXIT would seem to be the only realistic option at delivery if the parents are choosing trial of intervention. Comfort care would be the other option. Undiagnosed tracheal atresia is one of those nightmare forming scenarios in the delivery room for me. At least being diagnosed a plan can be made.

[M C Fadous Khalife]

The ENT has the key word 

Don't forget we have 3 types of tracheal atresia

Necessity to evaluate if complete absence of trachea or only proximal with fistula