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Arntzen T, Mikkelsen A, Emblem R, Lai X, Haugen G. Prenatal Diagnosis of Esophageal Atresia - Performance and Consequences. J Pediatr Surg 2023; 58:2075-2080. [PMID: 37407414 DOI: 10.1016/j.jpedsurg.2023.05.015] [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: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Prenatal diagnosis of congenital malformations is considered favorable. Esophageal atresia (EA) is prenatally detected in 10-40% of patients. The aims of our study were to assess factors influencing the prenatal detection rate and to study the outcome in EA patients with and without prenatal diagnosis. METHOD We included 136 patients in two time periods, group 1 (1996-2002, n = 68) and group 2 (2014-2020, n = 68). We registered clinical variables; prenatal signs, perinatal and postnatal outcome from the electronic patient record. RESULTS Twenty-five patients (18%) had a prenatal diagnosis of EA, significantly more during 2014-2020 (28%), than during 1996-2002 (9%). Patients with EA type A or B and with associated anomalies had increased likelihood of prenatal diagnosis, odds ratio (OR) 9.00 (1.99-40.69) and 3.53 (1.24-10.06), respectively. Among the 25 patients with prenatal diagnosis all had polyhydramnios and 16 had small/absent stomach. Prenatally diagnosed patients arrived significantly earlier at the surgical unit (median 2 h (2 h-1 days) vs 21 h (2 h-1275 days)), had more delayed primary anastomosis (OR 8.80 (2.68-28.92)) and anastomotic stricture (OR 3.11 (1.20-8.04)), longer length of stay (median 62 days (11-212 days) vs 20 days (2-270 days)) and longer time on ventilator (median 5 days (1-25 days) vs 1.5 days (0.5-33 days)) compared to patients without prenatal diagnosis. In multivariate analysis prenatal diagnosis predicts length of stay. CONCLUSION Prenatally diagnosed EA patients have more; type A and B malformations, associated anomalies and neonatal morbidity. Consequences of the assumed benefits of prenatal diagnosis; opportunity of early arrival to surgical care and prenatal counselling, must be further studied.
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Affiliation(s)
- T Arntzen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
| | - A Mikkelsen
- Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - R Emblem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - X Lai
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - G Haugen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Weissbach T, Kushnir A, Yousefi S, Massarwa A, Leibovitch L, Frank DD, Kidron D, Achiron R, Meyer R, Weisz B, Mazaki Tovi S, Kassif E. The prenatal detection of distal tracheoesophageal fistulas in fetuses diagnosed with esophageal atresia. Am J Obstet Gynecol 2022; 227:897.e1-897.e9. [PMID: 35940225 DOI: 10.1016/j.ajog.2022.06.065] [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: 04/23/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula. OBJECTIVE This study aimed to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia. STUDY DESIGN This was an observational study conducted at a single tertiary care center between 2019 and 2021. Included were pregnant patients carrying a fetus prenatally diagnosed with esophageal atresia that was confirmed postnatally during corrective surgery or at postmortem autopsy. During the scan, the performing investigator determined the presence or absence of a distal fistula by scanning the location of the lower esophagus during fetal breathing. Cases in which the lower esophagus was observed distending with amniotic fluid during breathing were deemed "fistula present," and the remaining cases "fistula absent." Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive value were calculated. The offline clips and images were reviewed by 2 investigators for the assessment of interoperator agreement using Cohen's Kappa formula. RESULTS Included were 16 fetuses with esophageal atresia scanned between 2019 and 2021. All fetuses were successfully scanned with sufficient resolution of the area of interest during at least 3 cycles of breathing. It took a median of 8.5 minutes to determine the presence or absence of a distal fistula. The feasibility of the test was 100% (16/16). The test's sensitivity, specificity, and positive and negative predictive values were 80% (95% confidence interval, 55-100), 100% (95% confidence interval, 60-100), 100% (95% confidence interval, 65-100), and 75% (95% confidence interval, 45-100), respectively. The Cohen's Kappa for interoperator agreement was calculated to be 1, P<.001, corresponding to a "perfect" level of agreement. CONCLUSION Distal fistulas in esophageal atresia can be demonstrated prenatally by targeted scanning using appropriate technique. The method provided is feasible, reproducible, and has excellent performance indices. This novel technique and observations may improve the prenatal diagnosis and counseling of esophageal atresia.
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Affiliation(s)
- Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel.
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shayan Yousefi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Abeer Massarwa
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Denise-Dana Frank
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Reuven Achiron
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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3
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Weissbach T, Kushnir A, Haber Kaptsenel E, Leibovitch L, Bilik R, Shinhar D, Karplus G, Achiron R, Kivilevitch Z, Barzilay E, Mazaki Tovi S, Weisz B, Kassif E. Oesophageal atresia: sonographic signs may prenatally predict surgical complexity. Arch Dis Child Fetal Neonatal Ed 2022; 107:206-210. [PMID: 34321245 DOI: 10.1136/archdischild-2021-321836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repair METHODS: Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed. RESULTS Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis. CONCLUSION OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.
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Affiliation(s)
- Tal Weissbach
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel .,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Anya Kushnir
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Leah Leibovitch
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Neonatology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Ron Bilik
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Daniel Shinhar
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Gideon Karplus
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Zvi Kivilevitch
- Women's Ultrasound Unit, Maccabi Health Services, Beer Sheva, Israel
| | - Eran Barzilay
- Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Shali Mazaki Tovi
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Kambe K, Fumino S, Sakai K, Higashi M, Aoi S, Furukawa T, Tajiri T. Predictive factors for fundoplication following esophageal atresia repair. Pediatr Int 2022; 64:e15026. [PMID: 34655254 DOI: 10.1111/ped.15026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/25/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the most frequent complications after repair of esophageal atresia (EA) is gastroesophageal reflux disease (GERD). Although GERD-associated EA is known to often require anti-reflux surgery, the predicting factors remain unclear. We retrospectively analyzed EA in our institution. METHODS Of 65 children with EA treated in our hospital from 1995 to 2018, 45 with Gross C type EA, followed for over 1 year, were enrolled in this study. The patients were divided into fundoplication and non-fundoplication groups and compared in terms of their clinical features. RESULTS The fundoplication and non-fundoplication groups included 13 and 32 cases, respectively. On univariate analysis, gestational age, body weight, prenatal diagnosis, polyhydramnios, re-do surgery, and gap length of the esophagus differed significantly between the groups (P < 0.05). CONCLUSION Early delivery, low body weight, and a long gap length are, are considered to be risk factors for fundoplication. However, the present study further showed that prenatal diagnosis and polyhydramnios were also significant contributing factors. The presence of a prenatal diagnosis and polyhydramnios may induce preterm delivery, therefore, cases of polyhydramnios due to suspected EA should be managed to prevent early delivery. Better understanding of the postnatal course after surgery is required, especially for prenatal diagnosis cases.
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Affiliation(s)
- Kosuke Kambe
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohei Sakai
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mayumi Higashi
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeyoshi Aoi
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taizo Furukawa
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Predictors of index admission mortality and morbidity in contemporary esophageal atresia patients. J Pediatr Surg 2020; 55:2322-2328. [PMID: 32200977 DOI: 10.1016/j.jpedsurg.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE The Spitz classification for esophageal atresia with/without tracheoesophageal fistula (EA/TEF) predicts mortality. This study evaluates the contemporary relevance of the Spitz classification and investigates predictors of morbidity. METHODS EA/TEF patients born between 1995 and 2018 at two centers were retrospectively reviewed. Clinical variables including sex, prenatal diagnosis, birth weight, prematurity, major congenital heart disease (MCHD), and pre-operative mechanical ventilation (POMV) were collected. Index admission composite morbidity was considered positive if: length-of-stay >90th percentile (139 days), ventilation days >90th percentile (24 days), and/or gastrostomy was used for long-term feeding. Multivariable regression determined predictors of index admission mortality and composite morbidity. A composite morbidity predictive algorithm was created. ROC curves evaluated model discrimination. RESULTS Of 253 patients, 13 (5.1%) experienced index admission mortality. Of the patients not suffering mortality, 74 (31.6%) experienced composite morbidity. Only MCHD predicted mortality (p = 0.001); birth weight did not (p = 0.173). There was no difference between the Spitz classification and MCHD alone in predicting mortality risk (p = 0.198); both demonstrated very good discrimination. Prenatal diagnosis, POMV, prematurity, and male sex predicted composite morbidity risk (p < 0.001; p = 0.008; p = 0.009; p = 0.05). An algorithm incorporating these predictors demonstrated good discrimination (AUC = 0.784; 95% CI: 0.724, 0.844). CONCLUSIONS The Spitz classification maintains contemporary relevance for mortality risk, though birth weight can be de-emphasized. A new morbidity risk algorithm is proposed for early postnatal counseling. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level IV.
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6
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Rohanizadegan M, Tracy S, Galarreta CI, Poorvu T, Buchmiller TL, Bird LM, Estroff JA, Tan WH. Genetic diagnoses and associated anomalies in fetuses prenatally diagnosed with esophageal atresia. Am J Med Genet A 2020; 182:1890-1895. [PMID: 32573094 DOI: 10.1002/ajmg.a.61639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022]
Abstract
Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to advances in prenatal imaging, EA is more readily diagnosed, but data on the associated genetic diagnoses, other anomalies, and postnatal outcome for fetuses diagnosed prenatally with EA are scarce. We collected data from two academic medical centers (n = 61). Our data included fetuses with suspected EA on prenatal imaging that was confirmed postnatally and had at least one genetic test. In our cohort of 61 cases, 29 (49%) were born prematurely and 19% of those born alive died in the first 9 years of life. The most commonly associated birth defects were cardiac anomalies (67%) and spine anomalies (50%). A diagnosis was made in 61% of the cases; the most common diagnoses were vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula with esophageal atresia, radial or renal dysplasia, and limb anomalies association (43%, although 12% met only 2 of the criteria), trisomy 21 (5%), and CHARGE syndrome (5%). Our findings suggest that most fetuses with prenatally diagnosed EA have one or more additional major anomaly that warrants a more comprehensive clinical genetics evaluation. Fetuses diagnosed prenatally appear to represent a cohort with a worse outcome.
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Affiliation(s)
- Mersedeh Rohanizadegan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina I Galarreta
- Department of Pediatrics, University of California, San Diego, California, USA
- Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Tabitha Poorvu
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California, San Diego, California, USA
- Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Judy A Estroff
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Undetected anomalies in foetuses with a prenatal diagnosis of isolated cleft. Int J Oral Maxillofac Surg 2020; 49:1576-1583. [PMID: 32546322 DOI: 10.1016/j.ijom.2020.05.005] [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: 10/18/2019] [Revised: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 11/22/2022]
Abstract
The aim of this study was to determine the rate of undetected additional anomalies following a prenatal diagnosis of isolated oral cleft. Data of all infants with a prenatal diagnosis of isolated oral cleft born between 2000 and 2015 were studied retrospectively. Additional anomalies detected after birth were categorized as minor or major and included structural and chromosomal anomalies. Isolated clefts of the lip (CL), lip and alveolus (CLA) and lip, alveolus, and palate (CLAP) were diagnosed prenatally in 176 live-born infants. The type of cleft was more extensive after birth in 34/176 (19.3%) and less extensive in 16/176 (9.1%) newborns. Additional anomalies were diagnosed in 24 infants (13.6%), of which 12 (6.8%) were categorized as major. The latter included two submicroscopic chromosome anomalies and two gene mutations. Postnatal additional anomalies occurred more frequently in CLA and CLAP than in CL, and more in bilateral than in unilateral clefts. Major anomalies are still found in infants with a prenatal diagnosis of an isolated oral cleft. The prevalence of additional anomalies seems to be related to the type and bilaterality of the cleft, and this should be considered during prenatal counselling.
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Dall'Asta A, Grisolia G, Nanni M, Volpe N, Schera GBL, Frusca T, Ghi T. Sonographic demonstration of fetal esophagus using three-dimensional ultrasound imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:746-751. [PMID: 30672651 DOI: 10.1002/uog.20221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility of antenatal direct visualization of normal and abnormal fetal esophagus using three-dimensional ultrasound (3D-US) with Crystal Vue rendering technology. METHODS Between February and April 2018, 3D-US volumes were collected from a non-consecutive series of singleton pregnancies, referred for clinically indicated detailed prenatal ultrasound at 19-28 weeks' gestation to one of two fetal medicine units in Italy. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Postprocessing with multiplanar mode was applied to orientate the volume and identify the esophagus. The region of interest was angled by approximately 30° to the spine and its thickness was adjusted in order to optimize visualization of the intrathoracic and intra-abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk in the coronal plane. Postnatal follow-up was available in all cases. RESULTS During the study period, 91 pregnancies met the inclusion criteria and were recruited. The study cohort included two pregnancies with suspicion of esophageal atresia due to suboptimal visualization of the stomach. Of the 89 cases with normal stomach on two-dimensional (2D) imaging, 3D-US with Crystal Vue rendering technology allowed direct evaluation of the whole course of the esophagus in 74 (83.1%). In the two cases with small or absent stomach bubble on 2D imaging, esophageal atresia was demonstrated antenatally on 3D Crystal Vue imaging and was confirmed postnatally. The mean time required for offline postprocessing and visualization of the esophageal anatomy was 4 min. CONCLUSIONS Using 3D-US with Crystal Vue rendering, it is possible to visualize antenatally the normal fetal esophagus and demonstrate presence of esophageal atresia. This should facilitate prenatal counseling and management of cases with suspected esophageal atresia. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Grisolia
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - M Nanni
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G B L Schera
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Fontanella F, Maggio L, Verheij JBGM, Duin LK, Adama Van Scheltema PN, Cohen‐Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Gracchi V, Oepkes D, Bilardo CM. Fetal megacystis: a lot more than LUTO. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:779-787. [PMID: 30043466 PMCID: PMC6593717 DOI: 10.1002/uog.19182] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/29/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Fetal megacystis presents a challenge in terms of counseling and management because of its varied etiology and evolution. The aim of this study was to present a comprehensive overview of the underlying etiologies and structural anomalies associated with fetal megacystis. METHODS This was a retrospective multicenter study of cases referred to the fetal medicine unit of one of the eight academic hospitals in The Netherlands with a diagnosis of fetal megacystis. For each case, data on and measurements of fetal urinary tract and associated structural anomalies were collected. All available postmortem examinations and postnatal investigations were reviewed in order to establish the final diagnosis. In the first trimester, fetal megacystis was defined as longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during an extended ultrasound examination lasting at least 40 min. RESULTS Of the 541 pregnancies with fetal megacystis, it was isolated (or solely accompanied by other signs of lower urinary tract obstruction (LUTO)) in 360 (67%) cases and associated with other abnormal ultrasound findings in 181 (33%) cases. The most common associated ultrasound anomaly was an increased nuchal translucency thickness (22%), followed by single umbilical artery (10%) and cardiac defect (10%). A final diagnosis was established in 418 cases, including 222 (53%) cases with isolated LUTO and 60 (14%) infants with normal micturition or minor isolated urological anomalies. In the remaining 136 (33%) cases, concomitant developmental or chromosomal abnormality or genetic syndrome was diagnosed. Overall, 40 chromosomal abnormalities were diagnosed, including trisomy 18 (n = 24), trisomy 21 (n = 5), Turner syndrome (n = 5), trisomy 13 (n = 3) and 22q11 deletion (n = 3). Thirty-two cases presented with anorectal malformations involving the anus, rectum and urogenital tract. In cases with confirmed urethral and anal atresia, megacystis occurred early in pregnancy and the bladder appeared severely distended (the LBD (in mm) was equal to or greater than twice the gestational age (in weeks)). Fetal macrosomia was detected in six cases and an overgrowth syndrome was detected in four cases, comprising two infants with Beckwith-Wiedemann syndrome and two with Sotos syndrome. Megacystis-microcolon-intestinal hypoperistalsis syndrome was diagnosed in five (1%) cases and prenatally suspected only in one case. CONCLUSIONS Although the main cause of fetal megacystis is LUTO, an enlarged fetal bladder can also be present as a concomitant finding of miscellaneous genetic syndromes, developmental disturbances and chromosomal abnormalities. We provide an overview of the structural anomalies and congenital disorders associated with fetal megacystis and propose a practical guide for the differential diagnosis of genetic syndromes and chromosomal and developmental abnormalities in pregnancies presenting with fetal megacystis, focusing on the morphological examination of the fetus. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. Fontanella
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - L. Maggio
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - J. B. G. M. Verheij
- Department of GeneticsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - L. K. Duin
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - P. N. Adama Van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAcademic Medical Center AmsterdamAmsterdamThe Netherlands
| | - M. Bekker
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisRadboud University Medical CenterNijmegenThe Netherlands
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. Willekes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisMaastricht University Medical Center, Grow School for Oncology and Medical BiologyMaastrichtThe Netherlands
| | - C. J. Bax
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisVU University Medical CenterAmsterdamThe Netherlands
| | - V. Gracchi
- Department of PediatricsUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - D. Oepkes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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10
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Pardy C, D'Antonio F, Khalil A, Giuliani S. Prenatal detection of esophageal atresia: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2019; 98:689-699. [PMID: 30659586 DOI: 10.1111/aogs.13536] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/25/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The primary aim of this systematic review was to quantify the diagnostic performance of ultrasound, magnetic resonance imaging and amniotic fluid analysis in detecting esophageal atresia prenatally. The secondary aim was to explore the accuracy of individual imaging signs in identifying this anomaly. MATERIAL AND METHODS MEDLINE, Embase and Cochrane databases were searched. The quality of studies was assessed using the revised tool for the quality assessment of diagnostic accuracy studies. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio for the predictive accuracy of ultrasound, magnetic resonance imaging and amniotic fluid analysis in detecting esophageal atresia were computed using the hierarchical summary receiver operating characteristic or DerSimonian-Laird random-effect model, according to the number of studies included in each analysis. PROSPERO registration number: CRD42017055828. RESULTS Twenty studies (73 246 fetuses, 1760 affected by esophageal atresia) were included. Overall, prenatal ultrasound had a sensitivity of 31.7%. Only two studies reported all data for diagnostic accuracy; based on these studies, prenatal ultrasound had a sensitivity of 41.9%, a specificity of 99.9%, a positive likelihood ratio of 88.1, a negative likelihood ratio of 0.58 and a diagnostic odds ratio of 153.7. Prenatal ultrasound correctly identified 77.9% of cases with esophageal atresia and 21.9% esophageal atresia with an associated tracheo-esophageal fistula. Polyhydramnios was present in 56.3% of cases affected by esophageal atresia, and a small or absent stomach was identified in 50.0% cases. When performed following a suspicious ultrasound, fetal magnetic resonance imaging had an good overall diagnostic accuracy for esophageal atresia, with a sensitivity of 94.7%, a specificity of 89.3%, a positive likelihood ratio of 8.8, a negative likelihood ratio of 0.06 and a diagnostic odds ratio of 149.3. Finally, amniotic fluid analysis with an esophageal atresia index ≥3 had a sensitivity of 89.9% and a specificity of 99.6% in detecting esophageal atresia. CONCLUSIONS Ultrasound alone is a poor diagnostic tool for identifying esophageal atresia prenatally, and has a high rate of false positive diagnoses. Magnetic resonance imaging and amniotic fluid analysis have high diagnostic accuracy for esophageal atresia. We would recommend their use following a suspicious ultrasound.
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Affiliation(s)
- Caroline Pardy
- Department of Pediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Francesco D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.,Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Stefano Giuliani
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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Abstract
Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care. These targeted perinatal interventions have been shown to improve outcome in selected diagnoses.
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Affiliation(s)
- Elizabeth K Sewell
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA
| | - Sarah Keene
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA.
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12
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Garabedian C, Bonnard A, Rousseau V, Sfeir R, Drumez E, Michaud L, Gottrand F, Houfflin-Debarge V. Management and outcome of neonates with a prenatal diagnosis of esophageal atresia type A: A population-based study. Prenat Diagn 2018; 38:517-522. [DOI: 10.1002/pd.5273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Affiliation(s)
- C. Garabedian
- Department of Obstetrics; CHU Lille; Lille France
- EA 4489-Perinatal Environment and Health; Univ. Lille; Lille France
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - A. Bonnard
- Department of Paediatric Surgery; University Hospital Robert Debré; Paris France
| | - V. Rousseau
- Department of Paediatric Surgery; University Hospital Necker-Enfants Malades; Paris France
| | - R. Sfeir
- Department of Paediatric Surgery; CHU Lille; Lille France
| | - E. Drumez
- Department of Biostatistics, EA 2694-Santé Publique : épidémiologie et qualité des soins; Univ. Lille, CHU Lille; Lille France
| | - L. Michaud
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - F. Gottrand
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - V. Houfflin-Debarge
- Department of Obstetrics; CHU Lille; Lille France
- EA 4489-Perinatal Environment and Health; Univ. Lille; Lille France
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13
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Piro E, Schierz IAM, Giuffrè M, Cuffaro G, La Placa S, Antona V, Matina F, Puccio G, Cimador M, Corsello G. Etiological heterogeneity and clinical variability in newborns with esophageal atresia. Ital J Pediatr 2018; 44:19. [PMID: 29373986 PMCID: PMC5787270 DOI: 10.1186/s13052-018-0445-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/02/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study was to define different characteristics of infants with esophageal atresia and correlations with neonatal level of care, morbidity and mortality occurring during hospital stay. METHODS Charts of all newborns with esophageal atresia (EA) admitted to our University NICU between January 2003 and November 2016 were reviewed and subdivided in four groups related to different clinical presentations; EA as an isolated form (A), with a concomitant single malformation (B), as VACTERL association (C), and in the context of a syndrome or an entity of multiple congenital anomalies (D). RESULTS We recruited 67 infants with EA (with or without tracheoesophageal fistula), distributed in groups as follows: A 31.3%, B 16.4%, C 26.8% and D 25.3%. Type of atresia was not statistically different among different groups. Mortality was higher in groups C and D, especially if associated with congenital heart defects. In survivors, we found different auxological evolution and prognostic profiles considering duration in days of invasive mechanical ventilation and total parenteral nutrition, as well as length of stay and corrected gestational age at discharge. CONCLUSIONS In the context of genetic and syndromic entities, subjects with VACTERL association showed a lower mortality rate although a higher and more complex level of intensive care was noted in comparison to infants without VACTERL genetic and syndromic entities.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Anal Canal/abnormalities
- Cohort Studies
- Databases, Factual
- Esophageal Atresia/diagnosis
- Esophageal Atresia/epidemiology
- Esophageal Atresia/genetics
- Esophagus/abnormalities
- Female
- Genetic Predisposition to Disease/epidemiology
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Hospital Mortality
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Kidney/abnormalities
- Length of Stay
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/epidemiology
- Limb Deformities, Congenital/genetics
- Male
- Prognosis
- Retrospective Studies
- Risk Assessment
- Spine/abnormalities
- Survival Analysis
- Trachea/abnormalities
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Affiliation(s)
- Ettore Piro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Cuffaro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Simona La Placa
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giuseppe Puccio
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Marcello Cimador
- Pediatric Surgical Unit. A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
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14
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Stoll C, Alembik Y, Dott B, Roth MP. Associated anomalies in cases with esophageal atresia. Am J Med Genet A 2017; 173:2139-2157. [DOI: 10.1002/ajmg.a.38303] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/25/2017] [Accepted: 05/06/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Claude Stoll
- Genetique Medicale; Faculte de Medecine; Strasbourg France
| | - Yves Alembik
- Genetique Medicale; Faculte de Medecine; Strasbourg France
| | - Beatrice Dott
- Genetique Medicale; Faculte de Medecine; Strasbourg France
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15
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Sadreameli SC, McGrath-Morrow SA. Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia. Paediatr Respir Rev 2016; 17:16-23. [PMID: 25800226 PMCID: PMC4559488 DOI: 10.1016/j.prrv.2015.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.
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16
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Hoopmann M, Kagan KO, Borgmeier F, Seitz G, Arand J, Wagner P. Measurement of Gastric Circumference in Foetuses with Oesophageal Atresia. Geburtshilfe Frauenheilkd 2015; 75:1148-1152. [PMID: 26719598 DOI: 10.1055/s-0035-1558172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: The specific recognition of oesophageal atresia (OA) with or without a tracheal fistula in a foetus is a diagnostic challenge for prenatal medicine. The aim of the present work is to analyse the value of the measurement of gastric size in the diagnosis of this significant malformation. Materials and Methods: Altogether, the examinations of 433 pregnancies between the 18.4 and 39.1 weeks of gestation were retrospectively analysed. 59 of these foetuses exhibited an OA. By means of a linear regression analysis with normal foetuses, significant parameters influencing gastric size were examined. Subsequently the gastric sizes were transformed into z values and a comparison was made between OA with and without fistulae with the help of t tests. Results: In the normal foetuses there was a significant association between the gastric circumference and the abdominal circumference (circumference = 6.809 + 0.179 × abdominal circumference, r = 0.686, p < 0.0001). In the normal group the average was 43.0 (standard deviation [SD] 13.7) mm and those in foetuses with and without fistuale were 33.8 (SD 22.7) and 0.9 (SD 3.7) mm. In 34 (57.6 %) foetuses with an OA, the gastric circumference was below the 5th percentile. In detail, there were 13 (34.2 %) foetuses with a fistula and 21 (100 %) without a fistula. The average z values in the normal group and in the groups of OA with fistula and without fistula amounted to 0.0 (SD 1.0), -1.3 (SD 2.2) and -4.5 (SD 1.0). Conclusion: Measurements of the gastric circumference below the 5th percentile should lead to further diagnostic measures, especially when associated with polyhydramnios. Although OA without a fistula is always conspicuous, only about one in three OAs with fistula are associated with a significantly smaller stomach.
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Affiliation(s)
- M Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - F Borgmeier
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - G Seitz
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tübingen
| | - J Arand
- Department of Neonatology, University Children's Hospital, Tübingen
| | - P Wagner
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
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17
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Garabedian C, Sfeir R, Langlois C, Bonnard A, Khen-Dunlop N, Gelas T, Michaud L, Auber F, Piolat C, Lemelle JL, Fouquet V, Habonima É, Becmeur F, Polimerol ML, Breton A, Petit T, Podevin G, Lavrand F, Allal H, Lopez M, Elbaz F, Merrot T, Michel JL, Buisson P, Sapin E, Delagausie P, Pelatan C, Gaudin J, Weil D, de Vries P, Jaby O, Lardy H, Aubert D, Borderon C, Fourcade L, Geiss S, Breaud J, Pouzac M, Echaieb A, Laplace C, Gottrand F, Houfflin-Debarge V. Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ? ACTA ACUST UNITED AC 2015; 44:848-54. [DOI: 10.1016/j.jgyn.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/09/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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18
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Spaggiari E, Faure G, Rousseau V, Sonigo P, Millischer-Bellaiche AE, Kermorvant-Duchemin E, Muller F, Czerkiewicz I, Ville Y, Salomon LJ. Performance of prenatal diagnosis in esophageal atresia. Prenat Diagn 2015; 35:888-93. [DOI: 10.1002/pd.4630] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Giuliana Faure
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | - Veronique Rousseau
- Department of Pediatric Surgery; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | - Pascale Sonigo
- Department of Radiology; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | | | - Elsa Kermorvant-Duchemin
- Department of Neonatalogy; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Francoise Muller
- Department of Biochemistry and Hormonology; AP-HP, Robert Debré Hospital; Paris France
- University Paris Ile de France Ouest; Versailles Saint-Quentin France
| | - Isabelle Czerkiewicz
- Department of Biochemistry and Hormonology; AP-HP, Robert Debré Hospital; Paris France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Laurent J. Salomon
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
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19
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Debost-Legrand A, Goumy C, Laurichesse-Delmas H, Déchelotte P, Perthus I, Francannet C, Lémery D, Gallot D. Prenatal diagnosis of the VACTERL association using routine ultrasound examination. ACTA ACUST UNITED AC 2015; 103:880-6. [DOI: 10.1002/bdra.23346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Debost-Legrand
- Service de Santé Publique, CHU Clermont-Ferrand; Clermont-Ferrand France
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
| | - Carole Goumy
- Service de Cytogénétique Médicale; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Hélène Laurichesse-Delmas
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Pierre Déchelotte
- Anatomie Pathologique; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Isabelle Perthus
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- CEMC-Auvergne; Clermont-Ferrand France
- Génétique Médicale, CHU Clermont-Ferrand; Clermont-Ferrand France
| | | | - Didier Lémery
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne; Clermont-Ferrand France
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
| | - Denis Gallot
- Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand; Clermont-Ferrand France
- R2D2-EA7281; Clermont Université, Université d'Auvergne; Clermont-Ferrand France
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20
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Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia? Am J Obstet Gynecol 2015; 212:340.e1-7. [PMID: 25265404 DOI: 10.1016/j.ajog.2014.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA. STUDY DESIGN We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year. RESULTS Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001). CONCLUSION Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
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21
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Schneider A, Blanc S, Bonnard A, Khen-Dunlop N, Auber F, Breton A, Podevin G, Sfeir R, Fouquet V, Jacquier C, Lemelle JL, Lavrand F, Becmeur F, Petit T, Poli-Merol ML, Elbaz F, Merrot T, Michel JL, Hossein A, Lopez M, Habonimana E, Pelatan C, De Lagausie P, Buisson P, de Vries P, Gaudin J, Lardy H, Borderon C, Borgnon J, Jaby O, Weil D, Aubert D, Geiss S, Breaud J, Echaieb A, Languepin J, Laplace C, Pouzac M, Lefebvre F, Gottrand F, Michaud L. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J Rare Dis 2014; 9:206. [PMID: 25496976 PMCID: PMC4265341 DOI: 10.1186/s13023-014-0206-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/02/2014] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA). Methods All 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database. Results From the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33–398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was −0.8 (range, −5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007). Conclusions Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding. Electronic supplementary material The online version of this article (doi:10.1186/s13023-014-0206-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Schneider
- Reference Center for Congenital Esophageal Anomalies, University Hospital Lille, Avenue Eugène Avinée, Lille, 59037, France.
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Demographic characteristics in patients with short-gap and long-gap esophageal atresia. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000452066.08719.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Clinical and etiological heterogeneity in patients with tracheo-esophageal malformations and associated anomalies. Eur J Med Genet 2014; 57:440-52. [DOI: 10.1016/j.ejmg.2014.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/20/2014] [Indexed: 12/12/2022]
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24
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Fallon SC, Ethun CG, Olutoye OO, Brandt ML, Lee TC, Welty SE, Ruano R, Cass DL. Comparing characteristics and outcomes in infants with prenatal and postnatal diagnosis of esophageal atresia. J Surg Res 2014; 190:242-5. [DOI: 10.1016/j.jss.2014.03.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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25
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Suivi à un an de l’atrésie de l’oesophage Résultats du registre national français. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Garabedian C, Vaast P, Bigot J, Sfeir R, Michaud L, Gottrand F, Verpillat P, Coulon C, Subtil D, Houfflin Debarge V. [Esophageal atresia: prevalence, prenatal diagnosis and prognosis]. ACTA ACUST UNITED AC 2014; 43:424-30. [PMID: 24440126 DOI: 10.1016/j.jgyn.2013.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/10/2013] [Accepted: 11/19/2013] [Indexed: 01/29/2023]
Abstract
Esophageal atresia (EA) is a rare congenital malformation (1 in 2,500 to 3,500 births). Prenatal diagnosis (PN) is particularly interesting allowing search for associated malformations related to worse prognosis forms (reference ultrasound, MRI and amniocentesis) and planning the birth in an adapted medico-surgical center. Diagnosis of EA is usually suspected because of indirect and non-specific signs: association of polyhydramnios and absent or small stomach bubble. The visualization in ultrasound or MRI of cervical or thoracic fluid image corresponding to the expansion of the bottom of upper esophageal ("pouch sign") increases the specificity of diagnosis. However, prenatal diagnosis remains difficult and less than 50 % of EA are diagnosed prenatally. Biochemical analysis could improve these results. If EA is confirmed at birth, surgical management consists in a primary end-to-end anastomosis in first days of life, or in two-steps surgery if the defect is too large. Although current prognosis of EA is good, frequency of surgical complications and esophageal lesions secondary to gastroesophageal reflux justify a systematic and multidisciplinary extended follow-up.
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Affiliation(s)
- C Garabedian
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - P Vaast
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - J Bigot
- Service d'imagerie de la femme, pôle de radiologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France
| | - R Sfeir
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France
| | - L Michaud
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - F Gottrand
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - P Verpillat
- Service d'imagerie de la femme, pôle de radiologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France
| | - C Coulon
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - D Subtil
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - V Houfflin Debarge
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
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Sfeir R, Bonnard A, Khen-Dunlop N, Auber F, Gelas T, Michaud L, Podevin G, Breton A, Fouquet V, Piolat C, Lemelle JL, Petit T, Lavrand F, Becmeur F, Polimerol ML, Michel JL, Elbaz F, Habonimana E, Allal H, Lopez E, Lardy H, Morineau M, Pelatan C, Merrot T, Delagausie P, de Vries P, Levard G, Buisson P, Sapin E, Jaby O, Borderon C, Weil D, Gueiss S, Aubert D, Echaieb A, Fourcade L, Breaud J, Laplace C, Pouzac M, Duhamel A, Gottrand F. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013; 48:1664-9. [PMID: 23932604 DOI: 10.1016/j.jpedsurg.2013.03.075] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. METHODS All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. RESULTS Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. CONCLUSIONS Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable.
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Affiliation(s)
- Rony Sfeir
- Reference Center for Congenital Oesophageal Anomalies, University Hospital Lille, France.
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28
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Kruse AY, Ho BTT, Phuong CN, Stensballe LG, Greisen G, Pedersen FK. Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam. BMC Pediatr 2012; 12:199. [PMID: 23272705 PMCID: PMC3554592 DOI: 10.1186/1471-2431-12-199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimated 17,000 neonates (≤ 28 days of age) die in Vietnam annually, corresponding to more than half of the child mortality burden. However, current knowledge about these neonates is limited. Prematurity, asphyxia and congenital malformations are major causes of death in neonates worldwide. To improve survival and long term development, these vulnerable neonates need access to the specialized neonatal care existing, although limited, in lower middle-income countries like Vietnam. The aim of this study was to describe these conditions in a specialized Vietnamese hospital, compared to a Danish hospital. METHODS We performed a comparative observational study of all neonates admitted to a tertiary pediatric hospital in South Vietnam in 2009-2010. The data were prospectively extracted from the central hospital registry and included basic patient characteristics and diagnoses (International Classification of Diseases, 10th revision). Prematurity, asphyxia and designated congenital malformations (oesophageal atresia, gastroschisis, omphalocoele, diaphragmatic hernia and heart disease) were investigated. In a subgroup, the prematurity diagnosis was validated using a questionnaire. The hospitalization ratio of each diagnosis was compared to those obtained from a Danish tertiary hospital. The Danish data were retrieved from the neonatal department database for a ten-year period. RESULTS The study included 5763 neonates (missing<1%). The catchment population was 726,578 live births. The diagnosis was prematurity in 7%, asphyxia in 2% and one of the designated congenital malformations in 6%. The diagnosis of prematurity was correctly assigned to 85% of the neonates, who were very premature or had very low birth weight according to the questionnaire, completed by 2196 neonates. Compared to the Danish Hospital, the hospitalization ratios of neonates diagnosed with prematurity (p<0.01), asphyxia (p<0.01) and designated congenital malformations (p<0.01- 0.04) were significantly lower. CONCLUSION Our findings suggest the investigated diagnoses were underrepresented in the Vietnamese study hospital. In contrast, relatively mild diagnoses were frequent. These results indicate the use of specialized care may not be optimal. Pre-hospital selection mechanisms were not investigated and additional studies are needed to optimise utilisation of specialized care and improve neonatal survival.
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Affiliation(s)
- Alexandra Y Kruse
- International Child Health Research Unit, JMC, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
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29
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Solomon BD, Bear KA, Kimonis V, de Klein A, Scott DA, Shaw-Smith C, Tibboel D, Reutter H, Giampietro PF. Clinical geneticists' views of VACTERL/VATER association. Am J Med Genet A 2012; 158A:3087-100. [PMID: 23165726 PMCID: PMC3507421 DOI: 10.1002/ajmg.a.35638] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 08/02/2012] [Indexed: 01/07/2023]
Abstract
VACTERL association (sometimes termed "VATER association" depending on which component features are included) is typically defined by the presence of at least three of the following congenital malformations, which tend to statistically co-occur in affected individuals: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Although the clinical criteria for VACTERL association may appear to be straightforward, there is wide variability in the way clinical geneticists define the disorder and the genetic testing strategy they use when confronted with an affected patient. In order to describe this variability and determine the most commonly used definitions and testing modalities, we present the results of survey responses by 121 clinical geneticists. We discuss the results of the survey responses, provide a literature review and commentary from a group of physicians who are currently involved in clinical and laboratory-based research on VACTERL association, and offer an algorithm for genetic testing in patients with this association.
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Affiliation(s)
- Benjamin D Solomon
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, USA.
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30
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Nassar N, Leoncini E, Amar E, Arteaga-Vázquez J, Bakker MK, Bower C, Canfield MA, Castilla EE, Cocchi G, Correa A, Csáky-Szunyogh M, Feldkamp ML, Khoshnood B, Landau D, Lelong N, López-Camelo JS, Lowry RB, McDonnell R, Merlob P, Métneki J, Morgan M, Mutchinick OM, Palmer MN, Rissmann A, Siffel C, Sìpek A, Szabova E, Tucker D, Mastroiacovo P. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. ACTA ACUST UNITED AC 2012; 94:893-9. [PMID: 22945024 DOI: 10.1002/bdra.23067] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012.
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Affiliation(s)
- Natasha Nassar
- Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Australia
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31
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Pinheiro PFM, Simões e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol 2012; 18:3662-72. [PMID: 22851858 PMCID: PMC3406418 DOI: 10.3748/wjg.v18.i28.3662] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/26/2011] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.
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32
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Kunisaki SM, Foker JE. Surgical advances in the fetus and neonate: esophageal atresia. Clin Perinatol 2012; 39:349-61. [PMID: 22682384 DOI: 10.1016/j.clp.2012.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article focuses on selected topics in the diagnosis and management of patients with esophageal atresia (EA) with or without tracheoesophageal fistula. The current status of prenatal diagnosis and recent advances in surgical techniques, including thoracoscopic repair for short-gap EA and tension-induced esophageal growth for long-gap EA, are reviewed. Although no consensus exists among pediatric surgeons regarding the role of these procedures in the treatment of EA, one can reasonably expect that, as they evolve, their application will become more widespread in this challenging patient population.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Fetal Diagnosis and Treatment Center, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Medical School, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48109, USA.
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