{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T18:24:12Z","timestamp":1769106252009,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T00:00:00Z","timestamp":1702080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Micrognathic neonates are at risk for upper airway obstruction, and many require intubation in the delivery room. Ex\u2010utero intrapartum treatment is one technique for managing airway obstruction but poses substantial maternal risks. Procedure requiring a second team in the operating room is an alternative approach to secure the obstructed airway while minimizing maternal risk.<\/jats:p><\/jats:sec><jats:sec><jats:label\/><jats:p>The aim of this study was to describe the patient characteristics, airway management, and outcomes for micrognathic neonates and their mothers undergoing a procedure requiring a second team in the operating room at a single quaternary care children's hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective descriptive study. Subjects had prenatally diagnosed micrognathia and underwent procedure requiring a second team in the operating room between 2009 and 2021. Collected data included infant characteristics, delivery room airway management, critical events, and medications. Follow\u2010up data included genetic testing and subsequent procedures within 90\u2009days. Maternal data included type of anesthetic, blood loss, and incidence of transfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen deliveries were performed via procedure requiring a second team in the operating room during the study period. 85.7% were male, and 50% had a genetic syndrome. Spontaneous respiratory efforts were observed in 93%. Twelve patients (85.7%) required an endotracheal tube or tracheostomy. Management approaches varied. Medications were primarily a combination of atropine, ketamine, and dexmedetomidine. Oxygen desaturation was common, and three patients experienced bradycardia. There were no periprocedural deaths. Follow\u2010up at 90\u2009days revealed that 78% of patients underwent at least one additional procedure, and one patient died due to an unrelated cause.<\/jats:p><jats:p>All mothers underwent cesarean deliveries under neuraxial anesthesia. Median blood loss was 700\u2009mL [IQR 700\u2009mL, 800\u2009mL]. Only one mother required a blood transfusion for pre\u2010procedural placental abruption.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Procedure requiring a second team in the operating room is a safe and effective approach to manage airway obstruction in micrognathic neonates while minimizing maternal morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Though shown to be safe and effective, more data are needed to support the use of procedure requiring a second team in the operating room as an alternative to ex\u2010utero intrapartum treatment for micrognathia outside of highly specialized maternal\u2013fetal centers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14806","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T11:00:21Z","timestamp":1702119621000},"page":"267-273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Immediate postdelivery airway management of neonates with prenatally diagnosed micrognathia: A retrospective observational study"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9857-3048","authenticated-orcid":false,"given":"Jessica A.","family":"Berger","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Staben","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luv R.","family":"Javia","sequence":"additional","affiliation":[{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Clinical Otorhinolaryngology: Head and Neck Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Division of Otolaryngology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-2579","authenticated-orcid":false,"given":"Allan\u00a0F.","family":"Simpao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nahla","family":"Khalek","sequence":"additional","affiliation":[{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Obstetrics &amp; Gynecology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Oliver","sequence":"additional","affiliation":[{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Radiology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. Scott","family":"Adzick","sequence":"additional","affiliation":[{"name":"Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Obstetrics &amp; Gynecology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Surgery Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaina E.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Richard D. 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