Baby's Life Saved by EXIT Procedure

Surgery done during delivery saves baby's life.

Nov. 9, 2010— -- Her newborn son's first cry was particularly emotional for Claudia Alonso, since a few months before he was born, doctors were worried that she would never see her baby.

When she was five months pregnant, doctors discovered a tumor in the unborn baby's jaw. His parents had already named him Benjamin.

"They did an ultrasound, and they measured my belly and it was bigger than usual," said Alonso. "It was from all the fluid he couldn't swallow because of the tumor."

"It was pretty obvious from in utero studies that the airway was obstructed, and if he weren't attended to quickly, he would not survive," said Dr. David Turbeville, one of Benjamin's doctors and the medical director of neonatal intensive care unit at Cook Children's Medical Center in Fort Worth, Tex.

The news devastated Alonso, about to become a mother for the second time.

"I was speechless and the doctor was staring at me. I wanted to cry but I didn't until I left the office."

Her heartache greatly diminished after she talked with Turbeville, who recommended a procedure called EXIT to remove the tumor from the baby's airway. EXIT is an operation done on a baby during Cesarean delivery to correct life-threatening problems. They're often done to clear blocked airways. Only a handful of medical centers in the country perform EXIT procedures.

"He told me that he was going to help me, and he's done it before," said Alonso.

Turbeville and a multidisciplinary team of doctors scheduled delivery for May 25.

"Once the head was delivered, we stopped delivery and the pediatric surgeon performed a tracheotomy below the mass so the child would have an airway," sadi Turbeville.

After the delicate tracheotomy, Benjamin Alonso fully entered the world and was immediately put on a ventilator. He stayed connected for several weeks. After that, he had two surgeries to decrease the size of the tumor, and also had a feeding tube inserted.

Although he was able to breathe, doctors couldn't guarantee his survival.

"They told his dad that they didn't know if he'd be able to survive the first 24 hours and that mass might be going into his brain," said Claudia Alonso.

Benjamin did pull through, though, and went home with his mother last week. He needs another surgery to remove the rest of the mass, but Turbeville said he's doing fine.

EXIT Procedures: Transition 'From Womb to World'

"EXIT procedures provide opportunities to relieve the birth defect or blockage in a controlled manner in an O.R. [operating room] setting at a time that's best for the baby," said Dr. F. Sessions Cole, professor of pediatrics and director of newborn medicine at Washington University School of Medicine in St. Louis. "They help provide a smooth transition from womb to world."

By using an EXIT procedure -- short for Ex-Utero Intrapartum Treatment -- experts say they can perform life-saving surgeries while ensuring the baby has oxygen, since it's still attached to the mother's umbilical cord and placenta. The umbilical cord is left unclamped during the procedure to allow the baby to get oxygenated blood through it.

Ideally, the procedure takes place close to the expected date of delivery.

"As long as the mother's health is OK, and fetal health is OK as determined by monitoring and ultrasound, in order to avoid the complications of premature birth, we do them as close to the delivery date as is feasible," said Cole.

Procedures Typically Safe for Mother and Baby

Turbeville said EXIT procedures are not uncommon. He does them about every other year, he said. Even though the procedure itself isn't rare, Benjamin Alonso's condition is.

"It's pretty unusual to see a tumor there, and it's also rare to see them large enough to obstruct the airway," he said.

"They're generally pretty uncommon birth defects that lead to these procedures," said Cole.

While Benjamin's prognosis has been good, doctors say how other babies fare depends on the nature of what caused them to have the procedure done in the first place. A blocked airway can be caused by a variety of problems, including tumors and genetic conditions.

EXIT procedures also don't generally pose a threat to the mother, unless she already has medical complications such as pre-eclampsia.

Claudia Alonso says she's thrilled that EXIT was a success for her and for Benjamin, whom she calls her "miracle baby." He's breathing on his own, and doctors think they'll be able to remove the feeding tube sometime soon.

His breathing tube came out on October 29, and he cried for the first time since he was born in May.

"I thought I was going to cry, too," his mother said.