1
|
Wild KT, Conlin L, Blair J, Manfredi M, Hamilton TE, Muir A, Zackai EH, Nace G, Partridge EA, Devine M, Reynolds T, Rintoul NE, Hedrick HL, Spinner N, Krantz ID. Genomic Contributors to Esophageal Atresia and Tracheoesophageal Fistula: A 12 Year Retrospective Review. J Pediatr 2024; 271:114060. [PMID: 38641166 DOI: 10.1016/j.jpeds.2024.114060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To evaluate genetic testing utilization and diagnostic yield in infants with esophageal atresia (EA)/tracheoesophageal fistula (TEF) over the past 12 years to inform future practices and individualize prognostication and management. STUDY DESIGN A retrospective cohort study was performed for all infants with EA or EA/TEF hospitalized between January 2011 and January 2023 at a quaternary children's hospital. For each infant, demographic information, prenatal and postnatal history, and genetic testing were reviewed. RESULTS There were 212 infants who were classified as follows: 1) complex/syndromic with EA/TEF plus an additional major anatomic anomaly (n = 114, of which 74 met VACTERL criteria); 2) isolated/nonsyndromic EA/TEF (n = 88) and 3) isolated/nonsyndromic EA (n = 10). A range of genetic tests were sent with varying diagnostic rates including karyotype analysis in 12 (all with complex/syndromic phenotypes and all positive), chromosomal microarray analysis in 189 (114 of whom were complex/syndromic with an overall diagnostic rate of 3/189), single gene testing for CHD7 in 18 (4 positive), and exome analysis in 37 complex/syndromic patients (8 positive). CONCLUSIONS EA/TEF with and without additional anomalies is genetically heterogeneous with a broad range of associated phenotypes. While the genetic etiology of EA/TEF with or without VACTERL remains largely unknown, genome wide testing (exome or genome) including copy number analysis is recommended over chromosomal microarray testing. We anticipate that expanded genetic/genomic testing modalities such as RNA sequencing and tissue specific molecular testing are needed in this cohort to improve our understanding of the genomic contributors to EA/TEF.
Collapse
Affiliation(s)
- K Taylor Wild
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; Division of Human Genetics, Roberts Individualized Medical Genetics Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Laura Conlin
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justin Blair
- Division of Human Genetics, Roberts Individualized Medical Genetics Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael Manfredi
- Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas E Hamilton
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Muir
- Division of Gastroenterology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Gary Nace
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Emily A Partridge
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew Devine
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Tom Reynolds
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Natalie E Rintoul
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Holly L Hedrick
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nancy Spinner
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ian D Krantz
- Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA; Division of Human Genetics, Roberts Individualized Medical Genetics Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
2
|
Wolfe C, Jnah A. Tracheoesophageal Fistula With Esophageal Atresia: A Case Series. Neonatal Netw 2024; 43:65-75. [PMID: 38599775 DOI: 10.1891/nn-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.
Collapse
|
3
|
Plutecki D, Ostrowski P, Bonczar M, Michalik W, Konarska-Włosińska M, Goncerz G, Juszczak A, Ghosh SK, Balawender K, Walocha J, Koziej M. Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis. HPB (Oxford) 2024; 26:486-502. [PMID: 38310080 DOI: 10.1016/j.hpb.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum. METHODS The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP. RESULTS A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%). CONCLUSION The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.
Collapse
Affiliation(s)
- Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland; Youthoria, Youth Research Organization, Kraków, Poland
| | - Patryk Ostrowski
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Weronika Michalik
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Grzegorz Goncerz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksiej Juszczak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Department of General Surgery, 5th Military Hospital, Kraków, Poland
| | - Sanjib K Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, 3rd Floor, Academic Building, Phulwarisharif, Patna, Bihar 801507, India
| | - Krzysztof Balawender
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Medical College, Rzeszow University, 35-315 Rzeszów, Poland
| | - Jerzy Walocha
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
| |
Collapse
|
4
|
Tousia A, Platzas I, Goutas N, Vlachodimitropoulos D, Katsos K, Kolentinis C, Piagkou M, Sakelliadis EI. Infant Pneumonitis Due to a Tracheoesophageal Fistula: A Presentation of Two Autopsy Cases. Cureus 2023; 15:e49959. [PMID: 38179357 PMCID: PMC10765552 DOI: 10.7759/cureus.49959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Both esophageal atresia (EA) and tracheoesophageal fistula (TEF) represent a rather uncommon congenital abnormality that is the result of abnormal tracheoesophageal organogenesis. Although EA, with or without TEF, is relatively uncommon, it represents the most common upper gastrointestinal birth defect. Esophageal atresia and tracheoesophageal fistula are anatomically classified into five types according to the Gross classification (types A, B, C, D, E/H). As in type E/H, the continuity of the esophagus is not interrupted, the symptom onset is consequently delayed, and therefore diagnosis is difficult. Aspiration pneumonitis is a chemical injury caused by inhaled sterile gastric contents, while aspiration pneumonia is, in part, an infectious process because the inhaled oropharyngeal secretions are rich in bacteria. This paper aims to report two infant autopsy cases of aspiration pneumonitis with TEF involvement. The main histopathological finding was interstitial pneumonitis. Upon histopathological examination, lymphocytes, plasma cells, and macrophages were discovered on the alveolar walls, which were compatible with the chemical origin of interstitial pneumonitis. No eosinophils were detected; therefore, hypersensitivity-originating interstitial pneumonitis was ruled out. The cause of death in both cases was interstitial pneumonitis.
Collapse
Affiliation(s)
- Athina Tousia
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ioannis Platzas
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Nikolaos Goutas
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Konstantinos Katsos
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Christoforos Kolentinis
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Maria Piagkou
- Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Emmanouil I Sakelliadis
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| |
Collapse
|
5
|
Galarreta CI, Hoyt E, Forero L, Curry CJ, Bird LM. Ear anomalies and hearing loss in patients with VACTERL association and the effect of maternal diabetes. Am J Med Genet A 2023; 191:2693-2702. [PMID: 37649433 DOI: 10.1002/ajmg.a.63382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
VACTERL association is typically defined as the presence of three components among these birth defects: vertebral anomalies, anal atresia, cardiac anomalies, esophageal atresia/tracheoesophageal fistula (EA/TEF), renal anomalies, and limb defects. There is increasing recognition that VACTERL and other recurrent constellations of embryonic development often overlap clinically and might share pathogenesis. We conducted a comprehensive chart review of a large patient population with VACTERL association from two tertiary care centers in California. We included patients with incomplete VACTERL expression, which we denoted as "partial VACTERL" (pVACTERL). We assessed the occurrence of craniofacial (CF) findings in these two groups and the combined cohort. We collected data on potential risk factors and demographic information such as sex, Hispanic ancestry, pregnancy complications, and maternal age. The study included 409 participants, of whom 263 had VACTERL and 146 pVACTERL. CF abnormalities were found in 17.3% of VACTERL patients and 9.4% of pVACTERL patients. In the VACTERL group, ear anomalies were found in 10.2%, microtia in 5.9%, hearing loss (HL) in 13.90%, and orofacial clefts in 3.1%. In the pVACTERL group, ear anomalies were found in 7.2%, microtia in 5.0%, HL in 9.3%, and orofacial cleft in 2.2%. Maternal diabetes significantly increased the risk for HL in VACTERL (odds ratio [OR]: 3.71, 95% confidence interval [CI]: 1.5-7.3) and pVACTERL patients (OR: 6.7, 95% CI: 1.70-23.4). Poorly controlled maternal diabetes significantly increased the risk for all the outcomes in VACTERL patients including CF anomalies (OR: 4.2, 95% CI: 1.9-9.6), ear anomalies (OR: 4.7, 95% CI: 1.8-11.8), microtia (OR: 5.4, 95% CI: 1.7-16.6), and HL (OR: 8.1, 95% CI: 3.4-19.4). Twin status was significantly associated with the occurrence of microtia (p = 0.038) in VACTERL patients. Occurrence of CF features, particularly ear anomalies, microtia, and HL, might be considered as part of phenotypic diversity of VACTERL association. Diabetes and twinning might appear to play a role in increasing the risk for this phenotype in VACTERL association.
Collapse
Affiliation(s)
- Carolina I Galarreta
- Department of Genetics and Metabolism, Valley Children's Hospital, Madera, California, USA
| | - Erin Hoyt
- Department of Pediatrics, Valley Children's Hospital, Madera, California, USA
| | - Laura Forero
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| | - Cynthia J Curry
- Department of Pediatrics, Genetic Medicine, UCSF/Fresno, Fresno, California, USA
| | - Lynne M Bird
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
6
|
Jung E. Minimally invasive management of combined esophageal atresia with tracheoesophageal fistula and duodenal atresia: a comprehensive case report. Front Pediatr 2023; 11:1252660. [PMID: 37744433 PMCID: PMC10514492 DOI: 10.3389/fped.2023.1252660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
A newborn presented with a rare combination of esophageal atresia with tracheoesophageal fistula (EA/TEF) and duodenal atresia (DA), which was successfully managed using minimally invasive surgical techniques. The patient was a 1-day-old male for whom passing a feeding tube was infeasible and who had a double bubble sign on radiography. The neonate underwent a thoracoscopic ligation of the tracheoesophageal fistula (TEF) and a laparoscopic duodeno-duodenostomy on the same day, resulting in stabilized vital signs. Ten days after the initial operation, a thoracoscopic esophago-esophagostomy was successfully performed. The patient demonstrated full feeding capability and normal weight gain after the surgeries. The co-occurrence of EA/TEF and DA is a rare and complex anomaly. This case indicates that minimally invasive techniques can effectively manage this condition.
Collapse
Affiliation(s)
- Eunyoung Jung
- Division of Pediatric Surgery, Department of Surgery, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| |
Collapse
|
7
|
Agurto-Ramírez A, García-Villodre L, Ruiz-Palacio A, Arribas-Díaz B, Barrachina-Bonet L, Páramo-Rodríguez L, Zurriaga Ó, Cavero-Carbonell C. Oesophageal Atresia: Prevalence in the Valencian Region (Spain) and Associated Anomalies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4042. [PMID: 36901053 PMCID: PMC10001480 DOI: 10.3390/ijerph20054042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The objective was to determine the prevalence of oesophageal atresia (OA) and describe the characteristics of OA cases diagnosed before the first year of life, born between 2007 and 2019, and residents in the Valencian Region (VR), Spain. Live births (LB), stillbirths (SB), and termination of pregnancy for fetal anomaly (TOPFA) diagnosed with OA were selected from the Congenital Anomalies population-based Registry of VR (RPAC-CV). The prevalence of OA per 10,000 births with 95% confidence interval was calculated, and socio-demographic and clinical variables were analyzed. A total of 146 OA cases were identified. The overall prevalence was 2.4/10,000 births, and prevalence by type of pregnancy ending was 2.3 in LB and 0.03 in both SB and TOPFA. A mortality rate of 0.03/1000 LB was observed. A relationship was found between case mortality and birth weight (p-value < 0.05). OA was primarily diagnosed at birth (58.2%) and 71.2% of the cases were associated with another congenital anomaly, mainly congenital heart defects. Significant variations in the prevalence of OA in the VR were detected throughout the study period. In conclusion, a lower prevalence in SB and TOPFA was identified compared to EUROCAT data. As several studies have identified, an association between OA cases and birth weight was found.
Collapse
Affiliation(s)
- Adriana Agurto-Ramírez
- Service of Preventive Medicine, Valencia General University Hospital Consortium, 46014 Valencia, Spain
| | - Laura García-Villodre
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| | - Ana Ruiz-Palacio
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| | - Berta Arribas-Díaz
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| | - Laia Barrachina-Bonet
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| | - Lucía Páramo-Rodríguez
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| | - Óscar Zurriaga
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
- Public Health Regional Health Administration, Generalitat Valenciana, 46020 Valencia, Spain
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, 46010 Valencia, Spain
| | - Clara Cavero-Carbonell
- Rare Diseases Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region-Valencia University (FISABIO-UVEG), 46020 Valencia, Spain
| |
Collapse
|
8
|
Geerts C, Sznajer Y, D'haenens E, Dumitriu D, Nassogne MC. Phenotypic spectrum of patients with Poretti-Boltshauser syndrome: Patient report of antenatal ventriculomegaly and esophageal atresia. Eur J Med Genet 2023; 66:104692. [PMID: 36592689 DOI: 10.1016/j.ejmg.2022.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/12/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
Poretti-Boltshauser syndrome (PTBHS) is an autosomal recessive disorder characterized by cerebellar dysplasia with cysts and an abnormal shape of the fourth ventricle on neuroimaging, due to pathogenic variants in the LAMA1 gene. The clinical spectrum mainly consists of neurological and ophthalmological manifestations, including non-progressive cerebellar ataxia, oculomotor apraxia, language impairment, intellectual disability, high myopia, abnormal eye movements and retinal dystrophy. We report a patient presenting with ventriculomegaly on antenatal neuroimaging and a neonatal diagnosis of Type III esophageal atresia. She subsequently developed severe myopia and strabismus with retinal dystrophy, mild developmental delay, and cerebellar dysplasia. Genetic investigations confirmed PTBHS. This report confirms previous reports of antenatal ventriculomegaly in PTBHS patients and documents a so far unreported occurrence of esophageal atresia in PTBHS. We additionally gathered phenotype and genotype descriptions of published cases in an effort to better define the spectrum of PTBHS.
Collapse
Affiliation(s)
- Chloé Geerts
- Paediatric Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | - Yves Sznajer
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Erika D'haenens
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Dana Dumitriu
- Paediatric Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Paediatric Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| |
Collapse
|
9
|
Khattar D, Suhrie KR. Esophageal Atresia With or Without Tracheoesophageal Fistula: Comorbidities, Genetic Evaluations, and Neonatal Outcomes. Cureus 2023; 15:e34779. [PMID: 36909054 PMCID: PMC10005847 DOI: 10.7759/cureus.34779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Objective Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) has a reported incidence of 1 in 3500 live births and requires intensive care and surgery. To evaluate the prevalence of a molecularly confirmed genetic etiology of EA/TEF in a level IV neonatal intensive care unit (NICU), focusing on genetic evaluation, diagnostic yield, and clinical outcomes of these neonates. Study design A retrospective cohort study over a period of seven years was performed for all patients admitted with a diagnosis of EA/TEF. Automated data was extracted for demographic information and manual extraction was done to evaluate the frequency of associated anomalies, type of genetic evaluations and diagnoses, and outcomes at NICU discharge. Results Sixty-eight infants met the inclusion criteria. The majority were male (n=42; 62%), born at >37 weeks' gestation (n=36; 53%), and had EA with distal TEF (n=54; 79%). Most (n=53; 78%) had additional associated congenital anomalies, but only 47 (69%) patients had a genetics evaluation performed and genetic testing was sent for 44 (65%) of those patients. The most common genetic testing performed was chromosomal microarray analysis (n=40; 59%), followed by chromosome analysis (n=11; 16%), and whole exome/genome sequencing (n=7; 10%). Five unique genetic diagnoses including CHARGE Syndrome, Fanconi Syndrome, EFTUD2-related mandibulofacial dysostosis, and two different chromosomal deletion syndromes were made for a total of nine (13%) patients in our cohort. The cohort suffered a high rate of morbidity and mortality during their NICU stay with important differences noted in isolated vs non-isolated EA/TEF. Twelve infants (18%) died prior to NICU discharge. Of those surviving, 40 (71%) infants had a primary repair, 37 (66%) infants required G or GJ feedings at NICU discharge, and eight (14%) patients were discharged on some type of respiratory support. Conclusion In this high-risk cohort of EA/TEF patients cared for at a quaternary NICU, a majority were non-isolated and had some form of a genetic evaluation, but a minority underwent exome or genome sequencing. Given the high prevalence of associated anomalies, high mortality, and genetic disease prevalence in this cohort, we recommend standardization of phenotyping and genetic evaluation to allow for precision care and appropriate risk stratification.
Collapse
Affiliation(s)
- Divya Khattar
- Department of Neonatal Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Kristen R Suhrie
- Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| |
Collapse
|
10
|
Ranza E, Le Gouez M, Guimier A, Dunlop NK, Beaudoin S, Malan V, Michot C, Baujat G, Rio M, Cormier-Daire V, Abadie V, Sarnacki S, Delacourt C, Lyonnet S, Attié-Bitach T, Pingault V, Rousseau V, Amiel J. Retrospective evaluation of clinical and molecular data of 148 cases of esophageal atresia. Am J Med Genet A 2023; 191:77-83. [PMID: 36271508 DOI: 10.1002/ajmg.a.62989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
Developmental abnormalities provide a unique opportunity to seek for the molecular mechanisms underlying human organogenesis. Esophageal development remains incompletely understood and elucidating causes for esophageal atresia (EA) in humans would contribute to achieve a better comprehension. Prenatal detection, syndromic classification, molecular diagnosis, and prognostic factors in EA are challenging. Some syndromes have been described to frequently include EA, such as CHARGE, EFTUD2-mandibulofacial dysostosis, Feingold syndrome, trisomy 18, and Fanconi anemia. However, no molecular diagnosis is made in most cases, including frequent associations, such as Vertebral-Anal-Cardiac-Tracheo-Esophageal-Renal-Limb defects (VACTERL). This study evaluates the clinical and genetic test results of 139 neonates and 9 fetuses followed-up at the Necker-Enfants Malades Hospital over a 10-years period. Overall, 52 cases were isolated EA (35%), and 96 were associated with other anomalies (65%). The latter group is divided into three subgroups: EA with a known genomic cause (9/148, 6%); EA with Vertebral-Anal-Cardiac-Tracheo-Esophageal-Renal-Limb defects (VACTERL) or VACTERL/Oculo-Auriculo-Vertebral Dysplasia (VACTERL/OAV) (22/148, 14%); EA with associated malformations including congenital heart defects, duodenal atresia, and diaphragmatic hernia without known associations or syndromes yet described (65/148, 44%). Altogether, the molecular diagnostic rate remains very low and may underlie frequent non-Mendelian genetic models.
Collapse
Affiliation(s)
- Emmanuelle Ranza
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Service de Médecine génétique, Hôpitaux Universitaires de Genève, Genève, Switzerland.,Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Morgane Le Gouez
- Service de Pédiatrie, Hôpital Necker-Enfants Malades (AP-HP), Paris, France
| | - Anne Guimier
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Naziha Khen Dunlop
- Service de Chirurgie Viscérale, Urologique et de Transplantation pédiatrique, Hôpital Universitaire Necker-Enfants Malades (AP-HP et Université de Paris), Paris, France
| | - Sylvie Beaudoin
- Service de Chirurgie Viscérale, Urologique et de Transplantation pédiatrique, Hôpital Universitaire Necker-Enfants Malades (AP-HP et Université de Paris), Paris, France
| | - Valérie Malan
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France
| | - Caroline Michot
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France
| | - Geneviève Baujat
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France
| | - Marlène Rio
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France
| | - Valérie Cormier-Daire
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Véronique Abadie
- Service de Pédiatrie, Hôpital Necker-Enfants Malades (AP-HP), Paris, France
| | - Sabine Sarnacki
- Service de Chirurgie Viscérale, Urologique et de Transplantation pédiatrique, Hôpital Universitaire Necker-Enfants Malades (AP-HP et Université de Paris), Paris, France
| | - Christophe Delacourt
- Service de Pneumologie Pédiatrique, Hôpital Necker-Enfants Malades (AP-HP), Paris, France
| | - Stanislas Lyonnet
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Tania Attié-Bitach
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Véronique Pingault
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Véronique Rousseau
- Service de Chirurgie Viscérale, Urologique et de Transplantation pédiatrique, Hôpital Universitaire Necker-Enfants Malades (AP-HP et Université de Paris), Paris, France
| | - Jeanne Amiel
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades (AP-HP centre), Paris, France.,Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| |
Collapse
|
11
|
Airway Management of Esophageal Atresia and Tracheoesophageal Fistula Combined with Anal Atresia. Case Rep Anesthesiol 2022; 2022:3775140. [PMID: 36106199 PMCID: PMC9467743 DOI: 10.1155/2022/3775140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Esophageal atresia (EA) associated with tracheoesophageal fistula (TEF) is a common congenital airway anomaly and may be associated with other gastrointestinal abnormalities. Neonates with EA/TEF are at high risk of gastrointestinal distension due to the shunting of air via the fistula, leading to progressive diaphragmatic elevation and regurgitation of the gastrointestinal contents. EA/TEF associated with anal atresia in a neonate makes airway management even more challenging particularly when managed for the repair of TEF through thoracotomy. Here, we report a case where we succeeded in conducting the flexible bronchoscopy insertion through a laryngeal mask to block the fistula by bronchial blocker under spontaneous breathing.
Collapse
|
12
|
Should all babies with oesophageal atresia have routine screening for midgut malrotation anomalies? A systematic review in search of evidence. J Pediatr Surg 2022; 57:655-660. [PMID: 34217510 DOI: 10.1016/j.jpedsurg.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background/Purpose Oesophageal Atresia (OA) is associated with co-existent anomalies. There is a controversy of literature pertaining to the risk (s) of intestinal malrotation. In order to guide management we critically evaluate the incidence of IM anomalies in OA newborns. Design MEDLINE and EMBASE databases were searched using keywords "(O)Esophageal Atresia and Malrotation/Associated Abnormalities/Associated Anomalies". Full texts of articles were screened if manuscripts exclusively reported patients with OA malrotation and/or associated anomalies. Larger case series (> 10patients) were included if abstract (s) showed that associated anomalies were systematically assessed. Full eligibility criteria required at least one case of malrotation in an OA index case. Data were collected on article type, number of patients and method (s) of diagnosis. Results 632 abstracts were screened of which 158 papers were analysed based on inclusion criteria-30 manuscripts documented the incidence (%) of malrotation. Incidence rate (s) were 0.5-13%. Malrotation was observed to have a higher incidence (10-44%) in OA babies with other gastrointestinal anomalies (VACTERL). Conclusion Newborns with OA appear to be at a higher risk (%) of having intestinal malrotation anomalies than healthy babies. Prospective studies are required to accurately quantify and define the ' true incidence ' of this association. Given the potential lethal consequences of midgut volvulus screening may be justified in OA babies. Consensus guidelines (DELPHI) exploring surgeons attitudes with regards management of ' asymptomatic malrotation ' disorders in OA newborns may further guide best practice.
Collapse
|
13
|
Reinicke T, Costantino CL, Anderson DJ, Tran J, Griggs C. A Network of Anomalies Prompting VACTERL Workup in a Trisomy 21 Newborn. Cureus 2022; 14:e21290. [PMID: 35186552 PMCID: PMC8846374 DOI: 10.7759/cureus.21290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities) association is a condition defined by having at least three of the following congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities. While diagnosing the VACTERL association is rare, the conditions that make up the VACTERL core-component features among other congenital abnormalities are even more unique. We present a case of a 34-week-old premature infant with trisomy 21 in addition to esophageal atresia, tracheoesophageal fistula, laryngeal cleft, vascular ring, Hirschsprung’s disease, atrioventricular canal defect, ventricular septal defect, and other related conditions diagnosed at birth. To our knowledge, this case represents the first of its kind in relation to the constellation of anomalies diagnosed in one individual at birth of which may or may not be related to Down syndrome, and the associated interventions necessary to continue postnatal living.
Collapse
|
14
|
Diagnostic Value of Prenatal Ultrasound Parameters and Esophageal Signs in Pouch and Lower Thoracic Segment in Fetuses with Esophageal Atresia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2021:8107461. [PMID: 34976113 PMCID: PMC8716201 DOI: 10.1155/2021/8107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
In order to investigate the diagnostic value of prenatal ultrasound parameters and signs of pouch and lower thoracic esophagus in the fetus with esophageal atresia (EA), the prenatal ultrasound data of 35 EA fetuses (observation group) confirmed by autopsy after induced labor or postnatal surgery and imaging examination in our hospital from May 2019 to May 2021 were retrospectively analyzed and compared with 35 normal postnatal fetuses (control group). General information and prenatal ultrasound parameters of the two groups, including head circumference (HC), abdominal circumference (AC), double parietal diameter (BPD), fetal body weight (EFW), and signs (small or unmanifested gastric vesicles, amniotic fluid, neck or upper chest pouch, lower chest esophagus not visible), were analyzed using logistic regression. The logistic multifactor regression model for EA diagnosis was established, and the diagnostic value for EA was analyzed. As a result, the HC, AC, and EFW of the observation group were lower than those of the control group, the gastric bubbles were small or not displayed, the amniotic fluid was more, and the signs of neck or upper chest pouch and lower chest esophagus were not visible in the observation group (P < 0.05). Logistic regression analysis showed that decreased ultrasound parameters HC, AC, EFW, small or no gastric bubble, amniotic fluid, neck or upper chest pouch, and no visible signs of lower chest esophagus were all risk factors for EA (P < 0.05). And in the prenatal ultrasound diagnostic model of EA was established, logistic (P) = −19.851 + HC × 0.384 + AC × 0.682 + EFW × 0.695 + small or no gastric vesicle × 3.747 + amniotic fluid × 3.607 + cervical or upper chest sac × 4.104 + invisible lower thoracic esophagus × 4.623.When logistic (P) > 0.468, AUC was 0.891, χ2 was 7.764, diagnostic sensitivity was 91.24%, and specificity was 79.22%. To draw a conclusion, prenatal ultrasound parameters and signs are of great value in the diagnosis of EA. Independent influencing factors of EA include small or no HC, AC, EFW and gastric vesicles, polyhydramnios, neck or upper chest pouch, and invisible lower thoracic esophagus. Logistic multifactor regression model has a high coincidence rate for the prenatal diagnosis of EA, providing a basis for clinical decision-making.
Collapse
|
15
|
Raad S, David A, Que J, Faure C. Genetic Mouse Models and Induced Pluripotent Stem Cells for Studying Tracheal-Esophageal Separation and Esophageal Development. Stem Cells Dev 2020; 29:953-966. [PMID: 32515280 PMCID: PMC9839344 DOI: 10.1089/scd.2020.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Esophagus and trachea arise from a common origin, the anterior foregut tube. The compartmentalization process of the foregut into the esophagus and trachea is still poorly understood. Esophageal atresia/tracheoesophageal fistula (EA/TEF) is one of the most common gastrointestinal congenital defects with an incidence rate of 1 in 2,500 births. EA/TEF is linked to the disruption of the compartmentalization process of the foregut tube. In EA/TEF patients, other organ anomalies and disorders have also been reported. Over the last two decades, animal models have shown the involvement of multiple signaling pathways and transcription factors in the development of the esophagus and trachea. Use of induced pluripotent stem cells (iPSCs) to understand organogenesis has been a valuable tool for mimicking gastrointestinal and respiratory organs. This review focuses on the signaling mechanisms involved in esophageal development and the use of iPSCs to model and understand it.
Collapse
Affiliation(s)
- Suleen Raad
- Esophageal Development and Engineering Laboratory, Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Anu David
- Esophageal Development and Engineering Laboratory, Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Jianwen Que
- Division of Digestive and Liver Diseases, Department of Medicine, Center for Human Development, Columbia University, New York, New York, USA
| | - Christophe Faure
- Esophageal Development and Engineering Laboratory, Sainte-Justine Research Centre, Montreal, Quebec, Canada.,Esophageal Atresia Clinic and Division of Pediatric Gastroenterology Hepatology and Nutrition, CHU Sainte Justine, Université de Montréal, Montréal, Quebec, Canada.,Address correspondence to: Dr. Christophe Faure, Division of Pediatric Gastroenterology, Sainte-Justine Hospital, 3715 Côte Sainte Catherine, Montreal H3T1C5, Quebec, Canada
| |
Collapse
|