May 21, 2018

Infant Ayala Was Born Through a Unique Exit Operation, surrounded by Multidisciplinary Physicians Due to Her Anticipated Respiratory Distress

Infant Ayala

Exit surgery is a planned caesarian section where the fetus suffers from blockage in the airways, undergoes evaluation and even surgical intervention at the moment of birth, with only his head delivered and he remains attached to the umbilical cord and the mother’s placenta to receive oxygen

5 EXIT procedures have been performed in the past two years-and-a-half years at Schneider Children’s

Infant Ayala was recently born through EXIT surgery performed at Schneider Children’s. While still in utero, a pregnancy scan showed swelling in the region of her neck on her airways, raising fears that she might not be able to breathe upon birth. Doctors recommended the EXIT procedure to the parents, an extension of a standard caesarian section performed where there is fear that the baby might be unable to breathe on her own after birth. EXIT procedures are rare and only a few have been done in the world.

The operation allows the infant to remain connected to the mother’s placenta through the umbilical cord so that he continues to receive oxygen during the first moments of his life, while doctors assess the situation and where needed, intervene immediately to remove the blockage.

This special technique, where the umbilical cord and placenta serve as a “heart-lung machine” providing the infant with oxygen, provide doctors with critical time to determine whether the infant can breathe on his own. If not, surgical intervention follows. Should the infant’s condition not be life-threatening, and there is no immediate need for surgical intervention, it is preferable to wait until the infant is older and gains weight before removing the blockage surgically.

In Ayala’s case, she did not breathe on her own, and doctors performed intubation to allow air to flow into her lungs, after which the umbilical cord was cut. She did not undergo further surgical intervention at this point as doctors felt the blockage did not pose an immediate danger to her life. After a few hours, she was weaned off the ventilator and started to breathe on her own. Ayala will undergo continued medical assessment over the coming weeks as to when surgical intervention will take place to remove the swelling in her neck.

This is the 5th time the EXIT procedure has been conducted at Schneider Children’s during the past two and-a-half years. As mentioned, the operation is very rare and is only performed in a few centers in the world. The complex procedure was conducted with the collaboration of broad team of specialists under Dr. Yoram Stern, Director of the Upper Airways Unit at Schneider Children’s and Dr. Yaacov Katz, Director of Anesthesiology and the Surgical Suite, together with ENTs, neonatologists, pulmonologists, intensivists, surgeons, gynecologists, surgical nurses and technicians.

The 5 surgeries were conducted in 5 women from all over the country who arrived especially to undergo the procedure at Schneider Children’s whose doctors are skilled in the treatment of premature and day-old infants especially those with significant blockages in the airway passages.

Dr. Stern noted that “EXIT procedures allow us to offer precise treatment to day-old infants whose lives, in other unprepared circumstances, would be in immediate and real danger at birth from losing his life. At Schneider, we are experienced in complex surgeries of the airway passages in premature infants and small babies, and I have no doubt that the superb teamwork between the various pediatric specialists and our pre-surgical preparation, ensured the effective treatment of the 5 infants.”