Dear Colleagues

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

Alok

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

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

 

 

 

 

 

 

 

 

 

 

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 

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.

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. 

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.

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

I'm belatedly catching up on old emails during retirement.

I once happened to be present in the delivery suite caring for a newly born preemie when unexpectedly a term baby was born with immediate severe respiratory distress. Initially I thought the baby might have tracheal stenosis, but when even a 2.5 ET wouldn't pass I suspected tracheal atresia. Assuming there was a potential for a fistula I intentionally intubated the esophagus (with a 3.5 ET as I recall) and the saturations promptly improved. We were able to maintain conventional ventilation via the fistula, and brought the baby to the OR for bronchoscopy and ENT evaluation. Unfortunately there were other severe anomalies including cardiac so the baby didn't survive but ventilation through an esophageal intubation bought us significant time.