International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

Michael D Puricelli; Reza Rahbar; Gregory C Allen; Karthik Balakrishnan; Matthew T Brigger; Sam J Daniel; Pierre Fayoux; Steven Goudy; Richard Hewitt; Wei-Chung Hsu; Jonathan B Ida; Romaine Johnson; Nicolas Leboulanger; Scott M Rickert; Soham Roy; John Russell; Michael Rutter; Douglas Sidell; Marlene Soma; Briac Thierry; Marilena Trozzi; George Zalzal; Carlton J Zdanski; Richard J H Smith

doi:10.1016/j.ijporl.2020.110281

International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

Int J Pediatr Otorhinolaryngol. 2020 Nov:138:110281. doi: 10.1016/j.ijporl.2020.110281. Epub 2020 Aug 8.

Authors

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

Affiliations

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.

PMID: 32891939
DOI: 10.1016/j.ijporl.2020.110281

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.

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).

MeSH terms

Airway Management
Airway Obstruction* / diagnosis
Airway Obstruction* / etiology
Airway Obstruction* / therapy
Child
Consensus
Female
Humans
Otolaryngology*
Placenta
Pregnancy