A 37-week-old newborn faced a critical challenge before he was even born. An enormous tumor mass near his throat prevented him from breathing at birth. The doctors intervened promptly, saving the life of the newborn still attached to the placenta; in a few crucial moments, the little patient was connected to a life support system before completing the caesarean section. It is the first known case in Italy of “EXIT-to-ECMO” cesarean section. The operation was performed at the San Pietro Fatebenefratelli Hospital by a multidisciplinary team coordinated by specialists from the Bambino Gesù pediatric hospital in Rome, where the tumor mass was also removed three days later. After 4 months, the child is well and has returned home with his family.
The little boy, suffering from a benign but rapidly growing tumor on his neck, presented unique challenges that prevented the use of traditional methods such as intubation or tracheotomy to facilitate breathing. During the pregnancy, the mother was followed by specialists who carefully monitored the tumor and planned the birth to deal with any eventuality.
3D reconstruction of the tumor mass of the small patient born with the EXIT-to-ECMO procedure
“EXIT to ECMO” allowed a delicate balance between maintaining circulation and oxygenation via the placenta and umbilical cord and performing critical procedures to ensure the baby's breathing. Given the inability to quickly access the airway, the only possible route was ECMO, which replaces the child's cardiac and respiratory functions from the outside, a complex maneuver performed with surgical precision. After birth, the newborn was promptly transferred to Bambino Gesù for surgery to remove the tumor, followed by a period of recovery and oncological treatments. Thanks to the commitment of the medical teams involved, the child was able to spend his first Christmas at home with his family, marking a happy ending to this extraordinary medical challenge.
Professionalism and synergy to save the little patient
The EXIT-to-ECMO cesarean section was successfully completed at the Maternal-Child Department of the San Pietro Fatebenefratelli Hospital in Rome thanks to the work of several teams coordinated by the heads of the Fetal-Neonatal and Cardiological Sciences Area of the Holy See Pediatric Hospital (Pietro Bagolan for the Research Area and Lorenzo Galletti for the Clinical Area).
In the case of the little patient, specialists from the Fetal and Perinatal Medicine and Surgery Units collaborated for the Bambino Gesù hospital; Cardiac Surgery, Neonatal Surgery, Neonatal Intensive Care; Otolaryngology; ECMO; Pediatric neuroresuscitation; Anesthesia and Resuscitation; Oncohematology, Hematopoietic Transplantation and Cellular Therapies and Pathological Anatomy. For the San Pietro Fatebenefratelli Hospital, the Obstetrics and Gynecology and Neonatal Intensive Care Units. In particular, the EXIT procedure was performed by Marco Bonito, director of the Maternal-Child Department of San Pietro Fatebenefratelli and by Leonardo Caforio, head of Fetal and Perinatal Medicine and Surgery of the Child Jesus. The placement of the child on ECMO was conducted by the cardiac surgeons Sonia Albanian and Gianluigi Perri, while the surgery to remove the tumor mass was led by Andrea Conforti, head of the Neonatal Surgery of Bambino Gesù.