Infant Ayala was recently born through EXIT surgery performed at Schneider Children’s. EXIT (ex utero intrapartum treatment) procedures are rare and only a few have been done in the world.
While still in utero, a pregnancy scan showed swelling in the region of Ayala’s neck possibly blocking her airways, and raising fears that she might not be able to breathe independently upon birth. Doctors recommended the EXIT procedure to the parents - an extension of a standard caesarian section where the baby is partially delivered, while doctors establish an airway so the fetus can breathe. Once the EXIT is complete, the infant is fully delivered.
This special technique, where the umbilical cord and placenta serve as a “heart-lung machine” providing the infant with precious oxygen during the first moments of life, give doctors critical time to assess and treat the infant with or without surgical intervention. Should the infant’s condition not be life-threatening, and there is no immediate danger, doctors prefer 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 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 previous EXIT surgeries were conducted in women from all over the country who arrived especially to undergo the procedure at Schneider Children’s. Doctors have skilled experience in treating 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. 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 all 5 infants.”