Only a tiny fraction of babies are diagnosed before birth with a blockage in their airway that would prove dangerous or deadly once separated from their mother—and life-sustaining oxygen flow—at delivery. But when this rare complication happens, Hackensack University Medical Center can rise to the challenge by performing an intricate and innovative surgery to safely transition these infants into the world.

Known as the EXIT (ex-utero intrapartum treatment) procedure, this special delivery is performed for babies with airway compression caused by cysts, tumors or other neck, jaw, throat or chest abnormalities. About 1 in 10,000 babies develops this problem during their mother’s pregnancy, according to Abdulla Al-Khan, M.D., vice-chair and division director of Maternal-Fetal Medicine & Surgery at Hackensack.

For only the third time in the last two decades at Hackensack, Dr. Al-Khan recently delivered a baby using the EXIT procedure, aided by a team of more than 20 colleagues including anesthesiologists, neonatologists, and ear, nose and throat doctors.

“The fact that we have an incredible team of specialists within the obstetrics and pediatrics departments allows us to tackle these conditions flawlessly and with relative ease,” says Dr. Al-Khan, also a professor of obstetrics and gynecology at Hackensack Meridian School of Medicine and director of Hackensack’s first-of-its-kind Center for Abnormal Placentation. “The key, especially when managing complex patients, is not doing things alone. Everyone’s role is equally important.”

While other medical centers around the United States can also perform the EXIT procedure, Hackensack—which handles more than 6,000 births annually, the most in New Jersey—draws difficult cases from across the country because of its standout Maternal-Fetal Medicine program, Dr. Al-Khan notes.

“If these patients go to a less-specialized facility, most doctors will transfer them to a facility with the capabilities to do an EXIT, such as ours,” he explains. 

More complex than a standard C-section birth, EXIT surgery requires meticulous preparation to carry out successfully. First, the mother is placed under general anesthesia to keep her uterus soft and relaxed. As the baby’s head and arms are delivered, he remains attached to the placenta through the umbilical cord while doctors clear his airway, placing a breathing tube or cutting a tracheotomy opening or otherwise securing oxygen flow before allowing the baby to fully emerge.

“It takes extreme planning to ensure everything goes flawlessly. That’s the critical thing with EXIT surgeries,” Dr. Al-Khan explains, noting that a step-wise series of plans are developed before each such birth in case one goes awry. “The biggest possible complication for the baby—the worst-case scenario—is an inability to establish an airway. The baby could die.”

But this devastating outcome has never occurred with a mother or baby undergoing EXIT surgery at Hackensack, Dr. Al-Khan says. Moreover, newborns delivered in this way typically undergo specialized surgery shortly after birth to remove their neck mass, remedying their original airway problem and ensuring they can thrive without needing to be transferred elsewhere for further treatment.

“Today we’re able to do this procedure with ease because of the strength of our staff and facility,” Dr. Al-Khan says. “It’s a testament to the growth of our organization.”

Yadira Luciano’s baby bump was so large that people often thought she was carrying twins. But the 36-year-old, also the mom of an older son, simply thought her second pregnancy had produced a bigger belly.

It turns out the reason was far more dangerous: Yadira’s unborn baby had developed a huge mass on his neck, preventing him from swallowing properly and getting rid of excess amniotic fluid. Her overstretched uterus then started contracting more than two months before her baby’s due date.

Fortunately, Yadira was referred to Hackensack and Dr. Al-Khan.  Her baby needed to be delivered via the unusual, specialized EXIT surgery.

In summer 2021, Dr. Al-Khan and a team of more than 20 other specialists stabilized Yadira’s pregnancy for several weeks before carefully collaborating in the operating room to deliver baby Yael, securing his airway and oxygen flow as he transitioned out of the womb.

Soon after, multidisciplinary specialists that included neonatologists, anesthesiologists, and ear, nose and throat doctors performed intricate surgery on newborn Yael to remove the mass on his neck. “It basically took a village, but it was the right way to proceed and we were successful,” Dr. Al-Khan recalls.

Yadira calls Dr. Al-Khan a “savior” and credits all team members who helped make the worst thing that ever happened—news that her child was in danger—possible to endure.

“I can’t say enough about how wonderful and caring everyone was during such a difficult time,” she says as she cradles Yael. “Dr. Al-Khan is a positive person, and I am very grateful he helped me do the only thing you can when something like this happens—put it in God’s hands.”