Newborn safely enters world after rare EXIT procedure

Lauren Sanford and Josh Setten of Tacoma, Wash., were delighted to learn in March that they were expecting a child.

Eighteen weeks into Lauren’s pregnancy, however, the couple learned that the fetus had a rare birth defect, Pierre Robin Sequence, which involves an underdeveloped jaw. But their fetus also appeared to have a normally developing tongue. The two conditions would make breathing impossible for the baby after a normal delivery.

Dr. Shani Delaney during the EXIT procedure on Nov. 16 at UW Medical Center – Montlake. 

The couple had never heard of the defect, much less the procedure to fix it.

“We connected with a lot of other families who have children with Pierre Robin Sequence,” Sanford said.  After talking with friends and doing their own research, they opted to have the delivery at UW Medicine in Seattle. Drs. Edith Cheng and Shani Delaney in the Department of Obstetrics and Gynecology became the couple's touchstones.

On Nov. 16, the Maternal Fetal Medicine team performed a rare procedure called ex utero intrapartum treatment, or EXIT, when the couple's son, Oliver, was partially delivered via cesarean. With Oliver still connected by umbilical to Sanford's placenta, UW Medicine and Seattle Children’s surgeons and other specialists cleared and stabilized his airway.

“We're allowing the placenta to continue to support the baby. We can then have our pediatric EMT and pediatric anesthesiologist come in and secure the airway of the baby,” said Cheng, who in 2010 became the first Pacific Northwest doctor to perform this procedure. UW Medical Center and Seattle Children’s experts collaborate on about two EXIT procedures per year, she said.

New parents Lauren Sanford and Josh Setten, with their newborn, Oliver.

“It was a little bit of a race,” added Delaney, who helped perform the 10-minute surgery that took days of preparation. “It’s a bit like pausing in midbirth.”

About 30 doctors and nurses were on hand to perform the procedure, deliver Oliver and tend to Lauren. She was awake during the delivery and Josh was there, too.

“I think it's amazing that there's this kind of medicine that allows them to operate on my baby while he's still receiving oxygen from me. That's pretty incredible," Sanford said.

Oliver is receiving care at Seattle Children’s and will soon undergo surgery to repair his cleft palate.

After that and other surgeries are complete, Oliver's breathing, eating and speech should develop normally, Delaney said – a prognosis which is this couple's holiday gift. 

– Barbara Clements,, 253-740-5043

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