EXIT-to-resection for fetuses with large lung masses and persistent mediastinal compression near birth

J Pediatr Surg. 2013 Jan;48(1):138-44. doi: 10.1016/j.jpedsurg.2012.10.067.


Purpose: To identify prenatal diagnostic features that will help select fetuses with lung masses (LM) who may benefit from ex-utero intrapartum treatment (EXIT procedure) as the preferred mode of delivery.

Methods: The CCAM-volume ratio (CVR), fetal treatment, and outcomes of all fetuses with LM evaluated between 2001 and 2011 were reviewed retrospectively. Fetuses with hydrops or CVR>1.6 were classified as high risk. Indications for fetal interventions included hydrops and heart failure, and indication for EXIT-to-resection was the finding of persistent mediastinal compression (PMC) near birth.

Results: Of 110 fetuses evaluated for LM, 78 were classified as low-risk. No fetus in this group had PMC near birth and none required perinatal treatment. Of 32 high-risk fetuses, 8 developed heart failure of which 4 survived (3 following fetal surgery). Nine high-risk fetuses with no PMC near birth were asymptomatic postnatally and treated electively. Sixteen high-risk fetuses had PMC near birth. All 9 babies with PMC treated with EXIT-to-resection did well with discharge at a median of 10 days post-operatively. All 7 fetuses treated without an EXIT developed respiratory distress following birth requiring an urgent operation; 2 died.

Conclusion: The EXIT-to-resection procedure is a favorable delivery approach for those fetuses with large LM and PMC near birth.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Cesarean Section*
  • Female
  • Humans
  • Hydrops Fetalis / diagnosis
  • Hydrops Fetalis / etiology
  • Infant, Newborn
  • Lung Diseases / complications
  • Lung Diseases / congenital
  • Lung Diseases / diagnosis
  • Lung Diseases / surgery*
  • Male
  • Mediastinal Diseases / diagnosis
  • Mediastinal Diseases / etiology*
  • Pneumonectomy / methods*
  • Pregnancy
  • Prenatal Diagnosis
  • Respiratory System Abnormalities / complications
  • Respiratory System Abnormalities / diagnosis
  • Respiratory System Abnormalities / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome
  • Young Adult