Predicting the Difficult Neonatal Airway in Fetuses With Micrognathia, Oropharyngeal or Neck Mass Lesions: Two‐Center Experience With Fetal MRI

• Published in: Prenatal diagnosis Vol. 44; no. 13; pp. 1593 - 1602
• Main Authors: Goergen, Stacy, Christie, James, Jackson, Tracy, Smet, Maria‐Elisabeth, Robertson, Simon, Malhotra, Atul, Kroushev, Annie, Lovell, Mark
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2024; John Wiley and Sons Inc
• Subjects: Adult; Airway Obstruction - congenital; Airway Obstruction - diagnostic imaging; Criteria; Deoxyribonucleic acid; DNA; Female; Fetuses; Head and Neck Neoplasms - diagnostic imaging; Humans; Infant, Newborn; Jaw; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Micrognathism - diagnostic imaging; Neck; Neonates; Original; Oropharyngeal Neoplasms - diagnostic imaging; Polyhydramnios - diagnostic imaging; Pregnancy; Prenatal Diagnosis - methods; Radiology; Respiratory tract; Retrospective Studies; Ultrasonic imaging; Ultrasonography, Prenatal - methods; Ultrasound
• ISSN: 0197-3851; 1097-0223; 1097-0223
• DOI: 10.1002/pd.6651

ABSTRACT Objective Neonatal airway compromise requiring intubation, due to micrognathia or a mass lesion obstructing the fetal airway, remains difficult but important to predict prenatally. We aimed to validate MR predictors of difficult neonatal airway (DNA) in a multicentre retrospective cohort of fetuses with micrognathia and oropharyngeal/neck masses. Method The radiology databases of two large Australian maternal–fetal medicine centers were searched for subjects meeting inclusion criteria: Pregnancies of > 18 weeks' gestation evaluated with prenatal ultrasound and MRI between 2007 and 2022 where either fetal micrognathia or a fetal cervical, oral or oropharyngeal mass was identified on prenatal ultrasound and MRI, and details of delivery/postnatal course were available including: nature of delivery, need for the fetal airway to be secured at delivery, degree of difficulty in airway securement, survival > 24 h postnatally. Imaging predictors of a difficult neonatal airway (DNA) were assessed blinded to these neonatal outcomes. Results Twenty‐six fetuses met the inclusion criteria. Oropharyngeal and neck mass location with polyhydramnios was 100% sensitive and 82% specific for DNA. JI < 5th centile with polyhydramnios was 83% sensitive and 70% specific. JI < 5th centile with polyhydramnios was associated with DNA in 80% of cases delivered by ex utero intrapartum (EXIT) delivery and none with non‐EXIT delivery mode. Conclusion A cervical or oropharyngeal mass with polyhydramnios predicted a difficult neonatal airway. Polyhydramnios with jaw index < 5th centile was less sensitive and less specific for a difficult neonatal airway.