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Hambraeus M, Börjesson A, Ekmark AN, Tofft L, Arnbjörnsson E, Stenström P. Genital Malformations in Children With VACTERL - Has Time Come to Include "G" in the Acronym? J Pediatr Surg 2024:S0022-3468(24)00306-3. [PMID: 38849227 DOI: 10.1016/j.jpedsurg.2024.05.005] [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: 02/24/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Genital malformations are frequently diagnosed in patients with VACTERL, but are currently not included in the acronym. This study aimed to analyze the frequency of genital anomalies in patients with esophageal atresia (EA) and/or anorectal malformation (ARM), with a subgroup analysis of children fulfilling the VACTERL criteria. METHOD This was a cross-sectional retrospective analysis of two prospectively collected registries of patients operated on for ARM and EA between 2012 and 2022 at a specialized national center. Children were screened routinely for malformations according to the VACTERL acronym. RESULTS A total of 174 children were included in the study. VACTERL was diagnosed in 60 children (34%), while 114 children (66%) were defined as non-VACTERL. Genital malformations were diagnosed in 38% (23/60) of the children with VACTERL, and in 11% (13/114) of the children without VACTERL (p < 0.001). The presence of genital malformations correlated linearly with the number of diagnosed component features (CFs). In boys with VACTERL, the most common genital malformation was undescended testes present in 10/27 (21%) compared to 1/71 (1%) in non-VACTERL boys (p < 0.001). Müllerian duct anomalies were found in 26% of girls with VACTERL vs. 7% in non-VACTERL girls (p < 0.05). CONCLUSION There was a higher frequency of genital malformations in patients with VACTERL emphasizing the importance of genital assessment for these patients. We propose VACTERL-G as an extension of the current acronym aiming to reduce the risk of long-term morbidity due to delayed diagnosis of reproductive anomalies. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mette Hambraeus
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden.
| | - Anna Börjesson
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Ann Nozohoor Ekmark
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Louise Tofft
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Einar Arnbjörnsson
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Pernilla Stenström
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
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van Hal AFRL, Vlot J, van Rosmalen J, Wijnen RMH, van Gils-Frijters APJM, Gischler SJ, Staals LM, IJsselstijn H, Rietman AB. Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study. Eur J Pediatr 2024; 183:2131-2140. [PMID: 38363392 PMCID: PMC11035457 DOI: 10.1007/s00431-024-05449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 - 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99-108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period. What is Known: • School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years. What is New: • Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age. • Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - John Vlot
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
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Forero LT, Henderson R, Galarreta C, Swee S, Bird LM. Expansion of the core features of VACTERL association to include genital anomalies. Am J Med Genet A 2024:e63587. [PMID: 38687163 DOI: 10.1002/ajmg.a.63587] [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: 12/07/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Genital anomalies have been reported with VACTERL association but not considered a core feature. Acute and chronic complications stemming from unrecognized genital anomalies have been reported in adolescents and young adults with VACTERL association. We sought to determine the frequency and severity of genital anomalies in VACTERL patients and identify which core features were more frequently associated with genital anomalies. A retrospective chart review from January 2010 to October 2021 identified 211 patients with two or more core VACTERL features, 34% of whom had a genital anomaly. The majority of genital anomalies (83% of those in males and 90% in females) were classified as functionally significant (requiring surgical intervention or causing functional impairment). The frequency of genital anomalies in the VACTERL cohort was higher if anorectal malformations or renal anomalies were present in both males and females and if vertebral anomalies were present in females. Due to their functional significance, genital anomalies should be assessed in all patients with two or more core features of VACTERL association, especially in those with anorectal or renal anomalies. Most genital anomalies in males will be detected on physical examination but additional investigation is often needed to detect genital anomalies in females. The timing and type of investigation are subjects for future study.
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Affiliation(s)
- Laura T Forero
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| | | | - Carolina Galarreta
- Department of Genetics and Metabolism, Valley Children's Hospital, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, California, USA
| | - Lynne M Bird
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
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4
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Asadov RI, Bernard E, Enelis B. Endoscopic Ventriculocysternostomy, Magendie Foraminoplasty, and Plexusectomy With Craniovertebral Shunt Placement in a Pediatric Patient With Hydrocephalus and VACTERL Association: A Novel Treatment Option. Cureus 2024; 16:e58845. [PMID: 38784296 PMCID: PMC11115447 DOI: 10.7759/cureus.58845] [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: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Endoscopic third ventriculocysternostomy (ETV) is a minimally invasive neurosurgical technique with good results in the treatment of obstructive hydrocephalus. The VACTERL (vertebrae, anorectal, cardiovascular, tracheal, esophageal, renal, limb defects) association, or VATER syndrome, is defined as congenital malformations, mostly derived from the mesoderm, affecting specific areas. It is diagnosed by the presence of at least three of the seven characteristic malformations that describe it. The association of this pathology and obstructive hydrocephalus in pediatric age is not common, making management and conventional neurosurgical procedures difficult due to the number of underlying pathologies. In this study, we report the management of hydrocephalus and VACTERL association with multiple congenital malformations in a 30-day-old premature neonate (birth at 29 weeks). Operations performed prior to admission to our service included: coloesophagoplasty and placement of esophagostoma in the left anterior cervical region, perineal anorectoplasty, gastrostomy and placement of sigmoidostomy in the left anterior abdominal wall, relaparotomy, gastric suture, sanitation, and abdominal drainage. Upon admission, the patient showed a Grade 3 intraventricular hemorrhage and internal occlusive hydrocephalus due to circulatory blockage of the cerebrospinal fluid (CSF) at the level of the outlet of the fourth ventricle. This was accompanied by intracranial hypertension and refractory cervical syringomyelia. We performed endoscopic ventriculocysternostomy plus plexusectomy plus Magendie foraminoplasty with craniovertebral shunt placement, achieving excellent results after two interventions. This is the first case described in the literature placing a craniovertebral shunt using a lateral-ventricle-to-the-subarachnoid-spinal-space-stenting technique in a patient with VACTERL association, which represents an innovation in the field of minimally invasive pediatric neurosurgery.
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Affiliation(s)
- Ruslan I Asadov
- Neurological Surgery, Scientific and Practical Center of Specialized Medical Care for Children Named After V.F. Voino-Yasenetsky of the Health Department of the City of Moscow, Moscow, RUS
| | - Edwin Bernard
- Neurosurgery, Russian University People's Friendship (RUDN) European Medical Centre (EMC) Medical School, Moscow, RUS
| | - Brenda Enelis
- Neurosurgery, Russian University People's Friendship (RUDN) European Medical Centre (EMC) Medical School, Moscow, RUS
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Feng W, Zhang M, Hou J, Die X, Wang Y, Liu R. Clinical characteristics of congenital heart defects in mild congenital anorectal malformation: single-centre experience. BMC Pediatr 2024; 24:71. [PMID: 38245711 PMCID: PMC10799376 DOI: 10.1186/s12887-023-04518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and types of congenital heart defect (CHD) in mild congenital anorectal malformation (CARM), namely the rectoperineal and rectovestibular fistulas. METHODS The retrospective study of 183 patients with mild CARM was conducted with assessments of demographic information, color Doppler echocardiography results, and follow-up data. We performed an analysis of the clinical characteristics of CHD, grouping them based on sex and type of mild CARM. RESULTS Of the 183 patients, rectoperineal fistula occurred in 133 patients (72.7%), while the frequency of CHD was 79.8% (146/183). Ventricular septal defects (VSDs) occur more frequently in patients with rectoperineal fistula compared to those with rectovestibular fistula (1.5% vs. 10%), while the opposite trend was observed for patent ductus arteriosus (PDAs) (39.8% vs. 22.0%). Additionally, males presented higher frequency of PDA (42.7% vs. 26.4%) and self-healing (6 months: 87.2% vs. 42.6%; 12 months: 91.0% vs. 63.2%) than females. However, males had a lower rate of undergoing cardiac surgery (6.4% vs. 17.6%) and a younger median diagnosis age (1 day vs. 9 days). CONCLUSION Our study indicates that there is a necessity for meticulous cardiac assessment and follow-up in neonates diagnosed with mild CARM.
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Affiliation(s)
- Wei Feng
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Minjie Zhang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jinping Hou
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xiaohong Die
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Wang
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
| | - Rong Liu
- Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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McMahon MJ, Evanovich DM, Pier DB, Kagan MS, Wang JT, Zendejas B, Jennings RW, Zurakowski D, Bajic D. Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure. Birth Defects Res 2024; 116:e2269. [PMID: 37936552 DOI: 10.1002/bdr2.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/04/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is limited knowledge regarding the impact of perioperative critical care on frequency of neurological imaging findings following esophageal atresia (EA) repair. METHODS This is a retrospective study of infants (n = 70) following EA repair at a single institution (2009-2020). Sex, gestational age at birth, type of surgical repair, underlying disease severity, and frequency of neurologic imaging findings were obtained. We quantified the length of postoperative pain/sedation treatment and anesthesia exposure in the first year of life. Data were presented as numerical sums and percentages, while associations were measured using Spearman's Rho. RESULTS Vertebral/spinal cord imaging was performed in all infants revealing abnormalities in 44% (31/70). Cranial/brain imaging findings were identified in 67% (22/33) of infants in the context of clinically indicated imaging (47%; 33/70). Long-gap EA patients (n = 16) received 10 times longer postoperative pain/sedation treatment and twice the anesthesia exposure compared with short-gap EA patients (n = 54). The frequency of neurologic imaging findings did not correlate with underlying disease severity scores, length of pain/sedation treatment, or cumulative anesthesia exposure. Lack of associations between clinical measures and imaging findings should be interpreted with caution given possible underestimation of cranial/brain findings. CONCLUSIONS We propose that all infants with EA undergo brain imaging in addition to routine spinal imaging given the high burden of abnormal brain/cranial findings in our cohort. Quantification of pain/sedation and anesthesia exposure in long-gap EA patients could be used as indirect markers in future studies assessing the risk of neurological sequelae as evidenced by early abnormalities on brain imaging.
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Affiliation(s)
- Maggie Jean McMahon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Devon Michael Evanovich
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Danielle Bennet Pier
- Division of Pediatric Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Mackenzie Shea Kagan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell William Jennings
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Tonni G, Koçak Ç, Grisolia G, Rizzo G, Araujo Júnior E, Werner H, Ruano R, Sepulveda W, Bonasoni MP, Lituania M. Clinical Presentations and Diagnostic Imaging of VACTERL Association. Fetal Pediatr Pathol 2023; 42:651-674. [PMID: 37195727 DOI: 10.1080/15513815.2023.2206905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
Background: VACTERL association consists of Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb defects. The diagnosis depends on the presence of at least three of these structural abnormalities. Methods: The clinical presentation and diagnostic prenatal imaging of VACTERL association are comprehensively reviewed. Results: The most common feature is a vertebral anomaly, found in 60-80% of cases. Tracheo-esophageal fistula is seen in 50-80% of cases and renal malformations in 30% of patients. Limb defects including thumb aplasia/hypoplasia, polydactyly, and radial agenesis/hypoplasia are present in 40-50% of cases. Anorectal defects, like imperforate anus/anal atresia, are challenging to detect prenatally. Conclusion: The diagnosis of VACTERL association mostly relies on imaging techniques such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis should exclude similar diseases such as CHARGE and Townes-Brocks syndromes and Fanconi anemia. New insights into genetic etiology have led to recommendations of chromosomal breakage investigation for optimal diagnosis and counseling.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Çağla Koçak
- Faculty of Medicine, Düzce Medical School, Duzce, Turkey
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Policlinic Hospital, University of Tor Vergata, Rome, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics and Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heron Werner
- Laboratorio de Biodesign (Dasa/PUC-Rio), Alta Excelência Diagnostica, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Ruano
- Fetal Surgery, Department of Maternal and Fetal Medicine, Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Waldo Sepulveda
- FETALMED, Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Maria Paola Bonasoni
- Pathology Unit, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Physiopathology, Department of Maternal & Neonatology, E.O. Ospedali Galliera, Genoa, Italy
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Evans-Barns HME, Porrett L, Hartmann PL, Taranto J, Jackson-Fleurus S, Dinning PG, Hutson JM, Teague WJ, King SK. Screening for VACTERL anomalies in children with anorectal malformations: Outcomes of a standardized approach. J Pediatr Surg 2023:S0022-3468(23)00087-8. [PMID: 36890099 DOI: 10.1016/j.jpedsurg.2023.01.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The majority of patients with an anorectal malformation (ARM) have associated congenital anomalies. It is well established that all patients diagnosed with an ARM should undergo systematic screening, including renal, spinal, and cardiac imaging. This study aimed to evaluate the findings and completeness of screening, following local implementation of standardized protocols. METHODS A retrospective cohort study was performed assessing all patients with an ARM managed at our tertiary pediatric surgical center, following a standardized protocol implementation for VACTERL screening (January 2016-December 2021). Cohort demographics, medical characteristics, and screening investigations were analyzed. Findings were compared with our previously published data (2000-2015), conducted prior to protocol implementation. RESULTS One hundred twenty-seven (64 male, 50.4%) children were eligible for inclusion. Complete screening was performed in 107/127 (84.3%) children. Of these, one or more associated anomalies were diagnosed in 85/107 (79.4%), whilst the VACTERL association was demonstrated in 57/107 (53.3%). The proportion of children that underwent complete screening increased significantly in comparison with those assessed prior to protocol implementation (RR 0.43 [CI 0.27-0.66]; p < 0.001). Children with less complex ARM types were significantly less likely to receive complete screening (p = 0.028). Neither presence of an associated anomaly, nor prevalence of the VACTERL association, differed significantly by ARM type complexity. CONCLUSION Screening for associated VACTERL anomalies in children with ARM was significantly improved following standardized protocol implementation. The prevalence of associated anomalies in our cohort supports the value of routine VACTERL screening in all children with ARM, regardless of malformation type. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hannah M E Evans-Barns
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Liesel Porrett
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Penelope L Hartmann
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jessica Taranto
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Jackson-Fleurus
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Phil G Dinning
- Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - John M Hutson
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
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9
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Successful Repair of TEF and DORV in a Child in a Resource-Limited Setting. Case Rep Cardiol 2023; 2023:1095670. [PMID: 36825212 PMCID: PMC9943623 DOI: 10.1155/2023/1095670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2023] Open
Abstract
VACTERL association is typically defined by the presence of at least three of the congenital malformations that make up the term including: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula (TEF), renal anomalies, and limb deformities. Patients with VACTERL are typically managed through immediate-postnatal-surgical correction of the specific congenital anomalies (typically anal atresia, specific types of cardiac malformations, and/or TEF), followed by long-term medical management of the congenital malformations. Although congenital anomalies might have long-lasting effects, the prognosis can be positive when the best surgical remedy is possible. Here, we present a case of 5 years female that is a known case of VACTERL Status Post (S/P)TEF repair, S/P double outlet right ventricle repair at sixth day and fifth month of life. This child managed to survive despite being operated in a resource-limited setting.
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10
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Jaouadi H, Theron A, Norscini G, Avierinos JF, Zaffran S. Genetic and phenotypic continuum of HOXA genes: A case with double HOXA9/HOXA13 mutations. Mol Med Rep 2023; 27:59. [PMID: 36734258 PMCID: PMC9936258 DOI: 10.3892/mmr.2023.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/30/2022] [Indexed: 02/04/2023] Open
Abstract
The HOXA genes cluster plays a key role in embryologic development. Mutations in HOXA genes have been linked to different human phenotypes, including developmental delay, limb anomalies, and urogenital malformations. The present study reported a clinical and genetic investigation of a female patient with polymalformative syndrome including left arm agenesis, bicornuate uterus and bicuspid aortic valve. Using whole exome sequencing, two heterozygous missense variants were identified. Of these, one was a novel variant in the HOXA13 gene [p.(Tyr290Ser)] and the second a heterozygous variant in the HOXA9 gene [p.(Ala102Pro)]. To the best of our knowledge, this is the first association of HOXA9/HOXA13 point mutations linked to a syndromic case. In conclusion, the present study suggested that the phenotypic spectrum of vertebral anomalies, anal atresia, cardiac defects, tracheo‑esophageal fistula, renal anomalies and limb abnormalities/hand‑foot‑genital syndrome may be attributable to the combination of different HOXA variants, particularly in patients with a severe clinical presentation. The current report contributed as well to the molecular understanding of HOXA genes‑related phenotypes via the identification of novel variant and genes associations.
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Affiliation(s)
- Hager Jaouadi
- Marseille Medical Genetics, U1251, National Institute of Health and Medical Research (INSERM), School of Medicine, Aix Marseille University, 13005 Marseille, France
| | - Alexis Theron
- Marseille Medical Genetics, U1251, National Institute of Health and Medical Research (INSERM), School of Medicine, Aix Marseille University, 13005 Marseille, France,Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Giulia Norscini
- Department of Cardiology, Public Assistance-Hospitals of Marseille, La Timone Hospital, 13005 Marseille, France
| | - Jean-François Avierinos
- Marseille Medical Genetics, U1251, National Institute of Health and Medical Research (INSERM), School of Medicine, Aix Marseille University, 13005 Marseille, France,Department of Cardiology, Public Assistance-Hospitals of Marseille, La Timone Hospital, 13005 Marseille, France
| | - Stéphane Zaffran
- Marseille Medical Genetics, U1251, National Institute of Health and Medical Research (INSERM), School of Medicine, Aix Marseille University, 13005 Marseille, France,Correspondence to: Dr Stéphane Zaffran, Marseille Medical Genetics, U1251, National Institute of Health and Medical Research (INSERM), School of Medicine, Aix Marseille University, 27 Bd Jean Moulin, 13005 Marseille, France, E-mail:
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11
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Huang H, Liu X, Li Z, Lin J, Yang H, Xu Z. Ectopic scrotum and penoscrotal transposition: Case report and literature review. Front Pediatr 2023; 11:1015384. [PMID: 36896407 PMCID: PMC9989158 DOI: 10.3389/fped.2023.1015384] [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: 08/09/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background Ectopic scrotum (ES) is an extremely rare congenital scrotal malformation. Ectopic scrotum with VATER/VACTERL [vertebral defects (V), anal atresia or anorectal malformations (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), cardiac defects, renal malformations (R), and limb defects (L)] association is even rarer. There are no uniform guidelines for diagnosis and treatment. Clinical case We described a 2-year-5-month-old boy who has ectopic scrotum and penoscrotal transposition and reviewed relevant literature in this report. We performed laparoscopy exploration, rotation flap scrotoplasty, and orchiopexy and achieved a great result during the postoperative follow-up. Conclusions Combined with the previous literature, we made a summary to come up with a plan for the diagnosis and treatment of ectopic scrotum. Rotation flap scrotoplasty and orchiopexy are worthy of considering operative methods in treating ES. For penoscrotal transposition or VATER/VACTERL association, we can treat the diseases individually.
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Affiliation(s)
- Haoran Huang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Zuoqing Li
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junjie Lin
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Yang
- Department of Pediatric Surgery, Meizhou People's Hospital, Meizhou, China
| | - Zhe Xu
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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12
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Ten Kate CA, Teunissen NM, van Rosmalen J, Kamphuis LS, van Wijk MP, Joosten M, van Tuyll van Serooskerken ES, Wijnen R, IJsselstijn H, Rietman AB, Spaander MCW. Development and validation of a condition-specific quality of life instrument for adults with esophageal atresia: the SQEA questionnaire. Dis Esophagus 2022; 36:6957244. [PMID: 36562092 DOI: 10.1093/dote/doac088] [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: 07/13/2022] [Revised: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The importance of multidisciplinary long-term follow-up for adults born with esophageal atresia (EA) is increasingly recognized. Hence, a valid, condition-specific instrument to measure health-related quality of life (HRQoL) becomes imperative. This study aimed to develop and validate such an instrument for adults with EA. The Specific Quality of life in Esophageal atresia Adults (SQEA) questionnaire was developed through focus group-based item generation, pilot testing, item reduction and a multicenter, nationwide field test to evaluate the feasibility, reliability (internal and retest) and validity (structural, construct, criterion and convergent), in compliance with the consensus-based standards for the selection of health measurement instruments guidelines. After pilot testing (n = 42), items were reduced from 144 to 36 questions. After field testing (n = 447), three items were discarded based on item-response theory results. The final SQEA questionnaire (33 items) forms a unidimensional scale generating an unweighted total score. Feasibility, internal reliability (Cronbach's alpha 0.94) and test-retest agreement (intra-class coefficient 0.92) were good. Construct validity was discriminative for esophageal replacement (P < 0.001), dysphagia (P < 0.001) and airway obstruction (P = 0.029). Criterion validity showed a good correlation with dysphagia (area under the receiver operating characteristic 0.736). SQEA scores correlated well with other validated disease-specific HRQoL scales such as the GIQLI and SGRQ, but poorly with the more generic RAND-36. Overall, this first condition-specific instrument for EA adults showed satisfactory feasibility, reliability and validity. Additionally, it shows discriminative ability to detect disease burden. Therefore, the SQEA questionnaire is both a valid instrument to assess the HRQoL in EA adults and an interesting signaling tool, enabling clinicians to recognize more severely affected patients.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadine M Teunissen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lieke S Kamphuis
- Department of Pulmonology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers-Emma Children's Hospital, Amsterdam, The Netherlands
| | - Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - René Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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13
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Schierz IAM, Piro E, Giuffrè M, Pinello G, Angelini A, Antona V, Cimador M, Corsello G. Clinical and genetic approach in the characterization of newborns with anorectal malformation. J Matern Fetal Neonatal Med 2022; 35:4513-4520. [DOI: 10.1080/14767058.2020.1854213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ingrid Anne Mandy Schierz
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Ettore Piro
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Mario Giuffrè
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Giuseppa Pinello
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Alice Angelini
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Vincenzo Antona
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Marcello Cimador
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Pediatric Surgery Unit, University Hospital “P. Giaccone”, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Neonatal Intensive Care Unit, University Hospital “P. Giaccone”, Palermo, Italy
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14
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The Incidence of Associated Anomalies in Children with Congenital Duodenal Obstruction-A Retrospective Cohort Study of 112 Patients. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121814. [PMID: 36553258 PMCID: PMC9776717 DOI: 10.3390/children9121814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Duodenal obstruction (DO) is a congenital anomaly that is highly associated with other anomalies, such as cardiac anomalies and trisomy 21. However, an overview of additional anomalies and patient-specific risk factors for cardiac anomalies is lacking. Potential association with the vertebral, anorectal, cardiac, trachea-esophageal, renal and limb anomalies (VACTERL) spectrum remains unknown. Therefore, we aim to examine the incidence of associated anomalies, a VACTERL-spectrum association and patient-specific risk factors for cardiac anomalies in patients with DO. METHODS A retrospective cohort study was performed between 1996 and 2021. Outcomes were the presence of any additional anomalies. Risk factors for cardiac anomalies were analyzed using multivariate logistic regression. RESULTS Of 112 neonates with DO, 47% (N = 53/112) had one associated anomaly and 38% (N = 20/53) had multiple anomalies. Cardiac anomalies (N = 35/112) and trisomy 21 (N = 35/112) were present in 31%. In four patients, VACTERL-spectrum was discovered, all with cardiac anomalies. Trisomy 21 was found to be a risk factor for cardiac anomalies (OR:6.5; CI-95%2.6-16.1). CONCLUSION Associated anomalies were present in half of patients with DO, of which cardiac anomalies and trisomy 21 occurred most often, and the VACTERL-spectrum was present in four patients. Trisomy 21 was a significant risk factor for cardiac anomalies. Therefore, we recommend a preoperative echocardiogram in patients with DO. In case a cardiac anomaly is found without trisomy 21, VACTERL-screening should be performed.
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15
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Predictors of Early Mortality in Esophageal Atresia: A 12-year Cohort Study in Tehran, Iran. IRANIAN JOURNAL OF PEDIATRICS 2022. [DOI: 10.5812/ijp-129266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Esophageal atresia and tracheoesophageal fistula (EA/TEF) is a known correctable anomaly of the esophagus, and its prognosis depends on multiple factors. Studies investigating the EA/TEF post-operative outcomes among the Iranian population are limited to small sample sizes, and the current prevalence of coexisting anomalies and predictors of poor prognosis in the Iranian population is still unclear. Objectives: This study aimed to investigate the predictors of in-hospital mortality in neonates with EA/TEF at our center within a 12-year period. Methods: In this retrospective cohort study, we investigated neonates with EA/TEF admitted/referred to a tertiary referral center in Tehran, Iran, from March 2008 to April 2020. Neonates with chromosomal anomalies or age > 10 days at operation date were excluded. Baseline characteristics, associated anomalies, type of EA, and transmission distance were compared in the study population. We followed the neonates for incurring in-hospital mortality. Results: We included 233 neonates in the final analysis. The mean age at operation was 3.1 ± 1.7 days, and 111 (47.6%) cases were female. The most common EA type was type C (proximal esophageal atresia with distal fistula), with a prevalence of 94.4%. In this cohort, 23 (9.9%) cases had vertebral anomalies, anal atresia, cardiovascular malformations, trachea-esophageal fistula, renal and limb anomalies (VACTERL) association, and 29 (12.4%) cases died during the in-hospital course. Moreover, neonates with lower birth weight, gestational birth weight < 37 weeks, other coexisting anomalies, cardiovascular defects, and non-VACTERL anomalies were at higher risk of in-hospital mortality. In contrast, EA types and transmission distance did not increase the mortality risk. Furthermore, we measured a cut-off value of < 2575.0 g for birth weight to predict in-hospital mortality with 65.5% sensitivity and 61.3% specificity. Conclusions: Lower birth weight, prematurity (< 37 weeks), and coexisting anomalies, especially cardiovascular defects, were associated with an increased risk of in-hospital mortality in neonates after EA/TEF repair surgery.
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16
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ten Kate CA, IJsselstijn H, Dellenmark-Blom M, van Tuyll van Serooskerken ES, Joosten M, Wijnen RMH, van Wijk MP. Psychometric Performance of a Condition-Specific Quality-of-Life Instrument for Dutch Children Born with Esophageal Atresia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101508. [PMID: 36291444 PMCID: PMC9600375 DOI: 10.3390/children9101508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
A condition-specific instrument (EA-QOL©) to assess quality of life of children born with esophageal atresia (EA) was developed in Sweden and Germany. Before implementing this in the Netherlands, we evaluated its psychometric performance in Dutch children. After Swedish−Dutch translation, cognitive debriefing was conducted with a subset of EA patients and their parents. Next, feasibility, reliability, and validity were evaluated in a nationwide field test. Cognitive debriefing confirmed the predefined concepts, although some questions were not generally applicable. Feasibility was poor to moderate. In 2-to-7-year-old children, 8/17 items had >5% missing values. In 8-to-17-year-old children, this concerned 3/24 items of the proxy-report and 5/14 items of the self-report. The internal reliability was good. The retest reliability showed good correlation. The comparison reliability between self-reports and proxy-reports was strong. The construct validity was discriminative. The convergent validity was strong for the 2-to-7-year-old proxy-report, and weak to moderate for the 8-to-17-year-old proxy-report and self-report. In conclusion, the Dutch-translated EA-QOL questionnaires showed good reliability and validity. Feasibility was likely affected by items not deemed applicable to an individual child’s situation. Computer adaptive testing could be a potential solution to customizing the questionnaire to the individual patient. Furthermore, cross-cultural validation studies and implementation-evaluation studies in different countries are needed.
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Affiliation(s)
- Chantal A. ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | - Michaela Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 41650 Gothenburg, Sweden
| | | | - Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center, Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | - Michiel P. van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC–Emma Children’s Hospital, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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17
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Altintas B, Giri N, McReynolds LJ, Best A, Alter BP. Genotype-phenotype and outcome associations in patients with Fanconi anemia: the National Cancer Institute cohort. Haematologica 2022; 108:69-82. [PMID: 35417938 PMCID: PMC9827153 DOI: 10.3324/haematol.2021.279981] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 02/04/2023] Open
Abstract
Fanconi anemia (FA) is caused by pathogenic variants in the FA/BRCA DNA repair pathway genes, and is characterized by congenital abnormalities, bone marrow failure (BMF) and increased cancer risk. We conducted a genotype-phenotype and outcomes study of 203 patients with FA in our cohort. We compared across the genes, FA/BRCA DNA repair pathways (upstream, ID complex and downstream), and type of pathogenic variants (hypomorphic or null). We explored differences between the patients evaluated in our clinic (clinic cohort) and those who provided data remotely (field cohort). Patients with variants in upstream complex pathway had less severe phenotype [lacked VACTERL-H (Vertebral, Anal, Cardiac, Trachea-esophageal fistula, Esophageal/duodenal atresia, Renal, Limb, Hydrocephalus) association and/or PHENOS (Pigmentation, small-Head, small-Eyes, Neurologic, Otologic, Short stature) features]. ID complex was associated with VACTERL-H. The clinic cohort had more PHENOS features than the field cohort. PHENOS was associated with increased risk of BMF, and VACTERL-H with hypothyroidism. The cumulative incidence of severe BMF was 70%, solid tumors (ST) 20% and leukemia 6.5% as the first event. Head and neck and gynecological cancers were the most common ST, with further increased risk after hematopoietic cell transplantation. Among patients with FANCA, variants in exons 27-30 were associated with higher frequency of ST. Overall median survival was 37 years; patients with leukemia or FANCD1/BRCA2 variants had poorest survival. Patients with variants in the upstream complex had better survival than ID or downstream complex (p=0.001 and 0.016, respectively). FA is phenotypically and genotypically heterogeneous; detailed characterization provides new insights towards understanding this complex syndrome and guiding clinical management.
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Affiliation(s)
- Burak Altintas
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Neelam Giri
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute,N. Giri
| | - Lisa J. McReynolds
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Ana Best
- Biostatistics Branch, Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Blanche P. Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute
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18
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Thiem CE, Stegmann JD, Hilger AC, Waffenschmidt L, Bendixen C, Köllges R, Schmiedeke E, Schäfer FM, Lacher M, Kosch F, Grasshoff-Derr S, Kabs C, Neser J, Jenetzky E, Fazaal J, Schumacher J, Hoefele J, Ludwig KU, Reutter H. Re-sequencing of candidate genes FOXF1, HSPA6, HAAO, and KYNU in 522 individuals with VATER/VACTERL, VACTER/VACTERL-like association, and isolated anorectal malformation. Birth Defects Res 2022; 114:478-486. [PMID: 35362267 DOI: 10.1002/bdr2.2008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The acronym VATER/VACTERL association describes the combination of at least three component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb defects (L). Individuals presenting two CFs have been termed VATER/VACTERL-like. Recently, FOXF1, HSPA6, HAAO, KYNU, TRAP1, and ZIC3 have been proposed as candidate genes for VATER/VACTERL, VATER/VACTERL-like, and ARM. Re-sequencing studies identified disease-causing variants in TRAP1 and ZIC3, the contribution of other genes was not independently investigated. One affected variant carrier in FOXF1 was previously identified. Here we re-sequenced FOXF1, HSPA6, HAAO, and KYNU in 522 affected individuals. METHODS Using molecular inversion probe (MIP) technology, re-sequencing was performed in 63 individuals with VATER/VACTERL association, 313 with VATER/VACTERL-like association, and 146 with ARM. All individuals were of European ethnicity. Variant filtering considered variants with a minor allele frequency (MAF) ≤0.01 for putative recessive disease-genes HSPA6, HAAO, and KYNU. For the putative dominant disease-gene FOXF1 we considered variants with a MAF ≤0.0001. In silico prediction tools were used for further prioritization. RESULTS Only two variants in FOXF1 in two independently affected individuals [c.443G>T, p.(Cys148Phe); c.850T>C, p.(Tyr284His)] passed our filter criteria. One individual presented with ARM, the second presented with TE and C comprising atrial and ventricular septal defects. Sanger sequencing confirmed both variants but also their inheritance from the healthy mother. CONCLUSION Our analysis suggests that FOXF1, HSPA6, HAAO and KYNU do not play a major role in the formation of VACTER/VACTERL phenotypes or ARM.
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Affiliation(s)
- Corina E Thiem
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Jil D Stegmann
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Alina C Hilger
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Research Center On Rare Kidney Diseases (RECORD), University Hospital Erlangen, Erlangen, Germany
| | - Lea Waffenschmidt
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Charlotte Bendixen
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Department of General, Visceral, Vascular and Thoracic Surgery, Unit of Pediatric Surgery, University Hospital Bonn, Bonn, Germany
| | - Ricarda Köllges
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Eberhard Schmiedeke
- Clinic for Paediatric Surgery and Paediatric Urology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Ferdinand Kosch
- Department of Pediatric Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Sabine Grasshoff-Derr
- Pediatric Surgery Unit, Buergerhospital and Clementine Kinderhospital, Frankfurt, Germany
| | - Carmen Kabs
- Department of Paediatrics Surgery, Muenchen Klinik gGmbH, Munich Clinic Schwabing, Munich, Germany
| | - Jörg Neser
- Department of Pediatric Surgery, General Hospital, Chemnitz, Germany
| | - Ekkehart Jenetzky
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Julia Fazaal
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kerstin U Ludwig
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, Medical Faculty of the University Bonn & University Hospital Bonn, Bonn, Germany.,Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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19
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Clinical spectrum of female genital malformations in prenatal diagnosis. Arch Gynecol Obstet 2022; 306:1847-1862. [DOI: 10.1007/s00404-022-06441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.
Methods
A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.
Results
First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.
Conclusions
This review is mainly directed towards the aspects of female genital malformations with aspects of male DSD explained as well to aid in the prenatal differential diagnosis.
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20
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Ten Kate CA, Rietman AB, van de Wijngaert Y, van Gils-Frijters A, Gischler SJ, Keyzer-Dekker CMG, Wijnen RMH, IJsselstijn H. Longitudinal Health Status and Quality of Life After Esophageal Atresia Repair. J Pediatr Gastroenterol Nutr 2021; 73:695-702. [PMID: 34508046 DOI: 10.1097/mpg.0000000000003293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To longitudinally evaluate self-reported and proxy-reported health status (HS) and quality of life (QoL) of school-aged children born with esophageal atresia (EA). METHODS We obtained Pediatric Quality of Life Inventory (HS) and DUX-25 (QoL) questionnaires from children born with EA between 1999 and 2011 at 8 and/or 12 years old. Children completed self-reports during neuropsychological assessments in a prospective longitudinal follow-up program. Parents filled out proxy-reports at home. Total and subscale scores were evaluated longitudinally and compared with sex-specific reference norms. RESULTS In total, 110 participants (62% boys) were included. Self-reported HS improved significantly between 8 and 12 years for both boys (mean difference [md] 4.35, effect size [ES] 0.54, P = 0.009) and girls (md 3.26, ES 0.63, P = 0.004). Proxy-reported HS tended to improve over time, while self-reported and proxy-reported QoL tended to decline. Self-reported HS at 8 years was below normal for both boys (md -5.44, ES -0.35, P < 0.001) and girls (md -7.61, ES -0.32, P < 0.001). Girls' self-reported QoL was below normal at 8 (md -5.00, ES -0.18, P = 0.019) and 12 years (md -10.50, ES -0.26, P = 0.001). Parents reported normal HS at both ages, whereas they rated the QoL of their daughters below normal at 12 years (md -10.00, ES -0.16, P = 0.022). All above results are total scores. CONCLUSIONS Self-reported and proxy-reported HS of children with EA improved between 8 and 12 years, while their QoL tended to decline. We recommend to consider HS and QoL as two separate concepts and to measure both simultaneously and longitudinally when evaluating the burden of disease.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yannick van de Wijngaert
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annabel van Gils-Frijters
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - Claudia M G Keyzer-Dekker
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC University Medical Centre - Sophia Children's Hospital
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21
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Kolvenbach CM, van der Ven AT, Kause F, Shril S, Scala M, Connaughton DM, Mann N, Nakayama M, Dai R, Kitzler TM, Schneider R, Schierbaum L, Schneider S, Accogli A, Torella A, Piatelli G, Nigro V, Capra V, Hoppe B, Märzheuser S, Schmiedeke E, Rehm HL, Mane S, Lifton RP, Dworschak GC, Hilger AC, Reutter H, Hildebrandt F. Exome survey of individuals affected by VATER/VACTERL with renal phenotypes identifies phenocopies and novel candidate genes. Am J Med Genet A 2021; 185:3784-3792. [PMID: 34338422 DOI: 10.1002/ajmg.a.62447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
The acronym VATER/VACTERL refers to the rare nonrandom association of the following component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A), cardiac anomalies (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb anomalies (L). For the clinical diagnosis, the presence of at least three CFs is required, individuals presenting with only two CFs have been categorized as VATER/VACTERL-like. The majority of VATER/VACTERL individuals displays a renal phenotype. Hitherto, variants in FGF8, FOXF1, HOXD13, LPP, TRAP1, PTEN, and ZIC3 have been associated with the VATER/VACTERL association; however, large-scale re-sequencing could only confirm TRAP1 and ZIC3 as VATER/VACTERL disease genes, both associated with a renal phenotype. In this study, we performed exome sequencing in 21 individuals and their families with a renal VATER/VACTERL or VATER/VACTERL-like phenotype to identify potentially novel genetic causes. Exome analysis identified biallelic and X-chromosomal hemizygous potentially pathogenic variants in six individuals (29%) in B9D1, FREM1, ZNF157, SP8, ACOT9, and TTLL11, respectively. The online tool GeneMatcher revealed another individual with a variant in ZNF157. Our study suggests six biallelic and X-chromosomal hemizygous VATER/VACTERL disease genes implicating all six genes in the expression of human renal malformations.
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Affiliation(s)
- Caroline M Kolvenbach
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Amelie T van der Ven
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Kause
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Shirlee Shril
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannia Gaslini, University of Genoa, Genoa, Italy
| | - Dervla M Connaughton
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina Mann
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makiko Nakayama
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rufeng Dai
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Kitzler
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronen Schneider
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luca Schierbaum
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Sophia Schneider
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Andrea Accogli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Gianluca Piatelli
- Department of Neurosurgery, Gaslini Children's Hospital, Genoa, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Valeria Capra
- Medical Genetics Unit, IRCCS Gianna Gaslini Institute, Genoa, Italy
| | | | - Stefanie Märzheuser
- Department of Pediatric Surgery, Campus Virchow Clinic, Charité University Hospital Berlin, Berlin, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Heidi L Rehm
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Shrikant Mane
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Center for Mendelian Genomics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Center for Mendelian Genomics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel C Dworschak
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany.,Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Alina C Hilger
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany.,Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, University Hospital Erlangen, Erlangen, Germany
| | - Friedhelm Hildebrandt
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Sreeram II, ten Kate CA, van Rosmalen J, Schnater JM, Gischler SJ, Wijnen RMH, IJsselstijn H, Rietman AB. Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies. CHILDREN-BASEL 2021; 8:children8070587. [PMID: 34356566 PMCID: PMC8307606 DOI: 10.3390/children8070587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022]
Abstract
Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.
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Affiliation(s)
- Isabel I. Sreeram
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Chantal A. ten Kate
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands;
- Department of Epidemiology, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes M. Schnater
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Saskia J. Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; (I.I.S.); (C.A.t.K.); (J.M.S.); (S.J.G.); (R.M.H.W.); (H.I.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)-10-7040209
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23
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The Classification of VACTERL Association into 3 Groups According to the Limb Defect. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3360. [PMID: 33680640 PMCID: PMC7929542 DOI: 10.1097/gox.0000000000003360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
The VACTERL association (VA) is defined as the nonrandom co-occurrence of 6 anomalies: vertebral anomalies (V), Anal atresia (A), Cardiac defects (C), Tracheo-esophageal fistula (TE), Renal defects (R), and Limb anomalies (L). The current communication presents an argument that patients with VA should be classified into three district groups based on their limb defects: VACTERL1: patients with normal limbs; VACTERL2: patients with limb anomalies other than radial ray defects of the upper limbs; and VACTERL3: patients with radial ray defects of the upper limbs. The author will demonstrate that the rationale behind the L1-3 classification in patients in VA is based on the embryogenesis of the 6 affected anatomical areas in VA. The pathogenesis of VACTERL1 is secondary to perturbations of Sonic Hedgehog (SHH) interactions. SHH signaling is known to have a major role in the normal development of the vertebrae, ano-rectal area, heart, tracheo-esophageal area, and kidney. However, SHH is not involved in the development of the radial ray; hence, patients present with no limb defects. The pathogenesis of VACTERL2 is variable depending on the type of gene mutation. The pathogenesis of VACTERL3 is related to errors in a group of proteins (namely, the proteins of the TBX5-SALL4-SALL1 loop and the FGF8-FGF10 loop/ pathway). These proteins are essential for the normal development of the radial ray and they interact in the development of the other anatomical areas of VA including the heart and kidney. Hence, VACTERL3 patients present with radial ray deficiency.
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24
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Moreno OM, Sánchez AI, Herreño A, Giraldo G, Suárez F, Prieto JC, Clavijo AS, Olaya M, Vargas Y, Benítez J, Surallés J, Rojas A. Phenotypic Characteristics and Copy Number Variants in a Cohort of Colombian Patients with VACTERL Association. Mol Syndromol 2021; 11:271-283. [PMID: 33505230 DOI: 10.1159/000510910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022] Open
Abstract
VACTERL association (OMIM 192350) is a heterogeneous clinical condition characterized by congenital structural defects that include at least 3 of the following features: vertebral abnormalities, anal atresia, heart defects, tracheoesophageal fistula, renal malformations, and limb defects. The nonrandom occurrence of these malformations and some familial cases suggest a possible association with genetic factors such as chromosomal alterations, gene mutations, and inherited syndromes such as Fanconi anemia (FA). In this study, the clinical phenotype and its relationship with the presence of chromosomal abnormalities and FA were evaluated in 18 patients with VACTERL association. For this, a G-banded karyotype, array-comparative genomic hybridization, and chromosomal fragility test for FA were performed. All patients (10 female and 8 male) showed a broad clinical spectrum: 13 (72.2%) had vertebral abnormalities, 8 (44.4%) had anal atresia, 14 (77.8%) had heart defects, 8 (44.4%) had esophageal atresia, 10 (55.6%) had renal abnormalities, and 10 (55.6%) had limb defects. Chromosomal abnormalities and FA were ruled out. In 2 cases, the finding of microalterations, namely del(15)(q11.2) and dup(17)(q12), explained the phenotype; in 8 cases, copy number variations were classified as variants of unknown significance and as not yet described in VACTERL. These variants comprise genes related to important cellular functions and embryonic development.
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Affiliation(s)
- Olga M Moreno
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana I Sánchez
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.,Departamento Materno Infantil, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana, Cali, Colombia.,Centro Médico Imbanaco de Cali, Cali, Colombia
| | - Angélica Herreño
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gustavo Giraldo
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.,Unidad de Genética Medica, Hospital Universitario de San Ignacio, Bogotá, Colombia
| | - Juan Carlos Prieto
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana Shaia Clavijo
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mercedes Olaya
- Servicio de Patología, Hospital Universitario de San Ignacio, Bogotá, Colombia
| | - Yaris Vargas
- Servicio de Pediatría, Neonatología, Hospital Universitario de San Ignacio, Bogotá, Colombia
| | - Javier Benítez
- CNIO: Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Jordi Surallés
- Departamento de Genética y Microbiología, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Adriana Rojas
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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25
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Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: ACOG Committee Opinion, Number 813. Obstet Gynecol 2020; 136:e90-e99. [PMID: 33093425 DOI: 10.1097/aog.0000000000004133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.
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26
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Stack M, Westmoreland T. Adolescent With VACTERL Association Presents With Recurrent Pneumonia. Cureus 2020; 12:e10365. [PMID: 33062488 PMCID: PMC7550003 DOI: 10.7759/cureus.10365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
VACTERL is a condition that includes various anatomic anomalies including vertebral, cardiac, tracheoesophageal fistula (TEF), renal, and limb defects. TEF can be found in up to 80% of patients with the condition. Although TEFs are usually identified early in life, the H-type TEF can be more difficult to detect. We report the case of a 15-year-old male with a previous diagnosis of VACTERL who presented with a history of recurrent pneumonia, chest pain, and asthma and was found to have a previously undetected H-type TEF that was surgically repaired. When evaluating a patient with features of VACTERL, it is important to choose studies that can explore the presence of all associated features. Clinical history and type of imaging utilized can be essential in making a timely diagnosis, especially for H-type TEF.
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Affiliation(s)
- Michael Stack
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Tamarah Westmoreland
- Pediatric Surgery, Nemours Children's Hospital, Orlando, USA.,Medicine, University of Central Florida College of Medicine, Orlando, USA
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27
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Spectrum of congenital anomalies among VACTERL cases: a EUROCAT population-based study. Pediatr Res 2020; 87:541-549. [PMID: 31499513 DOI: 10.1038/s41390-019-0561-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/20/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The VACTERL (Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, Limb abnormalities) association is the non-random occurrence of at least three of these congenital anomalies: vertebral, anal, cardiac, tracheo-esophageal, renal, and limb anomalies. Diagnosing VACTERL patients is difficult, as many disorders have multiple features in common with VACTERL. The aims of this study were to clearly outline component features, describe the phenotypic spectrum among the largest group of VACTERL patients thus far reported, and to identify phenotypically similar subtypes. METHODS A case-only study was performed assessing data on 501 cases recorded with VACTERL in the JRC-EUROCAT (Joint Research Centre-European Surveillance of Congenital Anomalies) central database (birth years: 1980-2015). We differentiated between major and minor VACTERL features and anomalies outside the VACTERL spectrum to create a clear definition of VACTERL. RESULTS In total, 397 cases (79%) fulfilled our VACTERL diagnostic criteria. The most commonly observed major VACTERL features were anorectal malformations and esophageal atresia/tracheo-esophageal fistula (both occurring in 62% of VACTERL cases), followed by cardiac (57%), renal (51%), vertebral (33%), and limb anomalies (25%), in every possible combination. Three VACTERL subtypes were defined: STRICT-VACTERL, VACTERL-LIKE, and VACTERL-PLUS, based on severity and presence of additional congenital anomalies. CONCLUSION The clearly defined VACTERL component features and the VACTERL subtypes introduced will improve both clinical practice and etiologic research.
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28
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Schierz IAM, Pinello G, Piro E, Giuffrè M, Cimador M, Corsello G. Congenital pelvic skeletal anomalies: Clinical and radiographic evaluation of newborns with gastrointestinal malformation. Early Hum Dev 2020; 141:104945. [PMID: 31901655 DOI: 10.1016/j.earlhumdev.2019.104945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Congenital pelvic skeletal anomalies (CPSA) may appear as isolated defects or in association with other anomalies like congenital malformations of the digestive system (CMDS). Minor CPSA in non-syndromic patients are often overlooked. We aimed to assess the frequency of CPSA in newborns with CMDS to review the diagnostic approaches. STUDY DESIGN A retrospective review of medical records of 201 newborns who underwent X-rays for different neonatal indications was conducted. In 122 patients CMDS were diagnosed and classified according to the ICD-10 classification; 79 non-CMDS patients acted as controls. Pelvic skeletal segments were examined by X-rays. RESULTS Patients with CMDS, showed a higher risk of CPSA (Odds ratio 2.89; 95% CI 1.34 6.23) and other associated malformations in comparison to non-CMDS patients. Newborns with malformations of the large intestine have the highest risk of adjacent CPSA (48%), as it is a developmental defect originating from the same somite. In addition to skeletal agenesis/hypoplasia, we reported dysmorphic and bifid vertebras, trident ileum, and elongated neural arches. CONCLUSIONS The high incidence of CPSA in CMDS suggests performing a routine radiographic pelvic evaluation in cases of CMDS in order to identify complex phenotypes that could originate from the same developmental field.
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Affiliation(s)
- Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127 Palermo, Italy.
| | - Giuseppa Pinello
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127 Palermo, Italy
| | - Ettore Piro
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127 Palermo, Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127 Palermo, Italy
| | - Marcello Cimador
- Pediatric Surgery Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Italy.
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127 Palermo, Italy
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Anesthesia Practice: Review of Perioperative Management of H-Type Tracheoesophageal Fistula. Anesthesiol Res Pract 2019; 2019:8621801. [PMID: 31781201 PMCID: PMC6875187 DOI: 10.1155/2019/8621801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 12/22/2022] Open
Abstract
Tracheoesophageal fistula (TEF) is a rare congenital developmental anomaly, affecting 1 in 2500-3000 live births. The H-type TEF, consisting of a fistula between the trachea and a patent esophagus, is one of the rare anatomic subtypes, accounting for 4% of all TEFs. The presentation and perioperative management of neonates with H-type TEFs and all other TEFs are very similar to each other. Patients present with congenital heart disease and other defects and are prone to recurrent aspirations. A barium esophagogram or computed tomography of the chest is a common means to the diagnosis, and surgical repair is carried out through either a cervical approach or a right thoracotomy. During operation, anesthetic management is focused on preventing positive pressure ventilation through the fistula in an attempt to minimize gastric distension. For patients with H-type TEFs, because of the patent esophagus, symptoms are often less severe and nonspecific, resulting in subtle yet important differences in their diagnostic workup and management. This review will cover the finer details in the diagnosis and perioperative anesthetic management of TEF patients and clarify how H-type TEF distinguishes itself from the other anatomic subtypes.
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30
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Yang L, Li S, Zhong L, Qiu L, Xie L, Chen L. VACTERL association complicated with multiple airway abnormalities: A case report. Medicine (Baltimore) 2019; 98:e17413. [PMID: 31626096 PMCID: PMC6824793 DOI: 10.1097/md.0000000000017413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION VACTERL association is an acronym that includes vertebral anomalies (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TEF) or esophageal atresia (EA), renal anomalies (R), and limb defects (L). Airway anomalies have rarely been reported with VACTERL association. PATIENT CONCERNS A 10-month-old boy who had been diagnosed with anal atresia and received surgical corrections soon after birth consulted our institution by complaining repeated cough and fever. DIAGNOSIS Diagnosis of VACTERL association was finally made. Bronchoscopy and chest CT with computed tomography angiography confirmed multiple airway abnormalities including bridging bronchus, airway malacia, and complete tracheal rings. INTERVENTIONS Supplemental oxygen was provided and antibiotics was initiated. OUTCOMES The patient resolved gradually and was discharged 10 days later. The follow-up showed the patient has remained well just with mild psychomotor retardation. CONCLUSION Multiple airway anomalies may be seen in VACTERL association. It is worthwhile to make special note for evaluating the tracheobronchial pulmonary system by chest CT and bronchoscopy, especially patients presenting with breathing anomalies.
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Affiliation(s)
- Lin Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
| | - Shu Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
| | - Lin Zhong
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
| | - Li Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
| | - Liang Xie
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
| | - Lina Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University,
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University,
- Lab of Vascular Remodeling and Developmental Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, Peoples’ Republic of China
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31
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Kruger P, Teague WJ, Khanal R, Hutson JM, King SK. Screening for associated anomalies in anorectal malformations: the need for a standardized approach. ANZ J Surg 2019; 89:1250-1252. [DOI: 10.1111/ans.15150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Kruger
- Department of Paediatric SurgeryThe Royal Children's Hospital Melbourne Victoria Australia
- Surgical ResearchMurdoch Children's Research Institute Melbourne Victoria Australia
| | - Warwick J. Teague
- Department of Paediatric SurgeryThe Royal Children's Hospital Melbourne Victoria Australia
- Surgical ResearchMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
| | - Rija Khanal
- Department of Paediatric SurgeryThe Royal Children's Hospital Melbourne Victoria Australia
- Surgical ResearchMurdoch Children's Research Institute Melbourne Victoria Australia
| | - John M. Hutson
- Surgical ResearchMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
- Department of UrologyThe Royal Children's Hospital Melbourne Victoria Australia
| | - Sebastian K. King
- Department of Paediatric SurgeryThe Royal Children's Hospital Melbourne Victoria Australia
- Surgical ResearchMurdoch Children's Research Institute Melbourne Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
- Department of Gastroenterology and Clinical NutritionThe Royal Children's Hospital Melbourne Victoria Australia
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32
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van Lennep M, Singendonk MMJ, Dall'Oglio L, Gottrand F, Krishnan U, Terheggen-Lagro SWJ, Omari TI, Benninga MA, van Wijk MP. Oesophageal atresia. Nat Rev Dis Primers 2019; 5:26. [PMID: 31000707 DOI: 10.1038/s41572-019-0077-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Oesophageal atresia (EA) is a congenital abnormality of the oesophagus that is caused by incomplete embryonic compartmentalization of the foregut. EA commonly occurs with a tracheo-oesophageal fistula (TEF). Associated birth defects or anomalies, such as VACTERL association, trisomy 18 or 21 and CHARGE syndrome, occur in the majority of patients born with EA. Although several studies have revealed signalling pathways and genes potentially involved in the development of EA, our understanding of the pathophysiology of EA lags behind the improvements in surgical and clinical care of patients born with this anomaly. EA is treated surgically to restore the oesophageal interruption and, if present, ligate and divide the TEF. Survival is now ~90% in those born with EA with severe associated anomalies and even higher in those born with EA alone. Despite these achievements, long-term gastrointestinal and respiratory complications and comorbidities in patients born with EA are common and lead to decreased quality of life. Oesophageal motility disorders are probably ubiquitous in patients after undergoing EA repair and often underlie these complications and comorbidities. The implementation of several new diagnostic and screening tools in clinical care, including high-resolution impedance manometry, pH-multichannel intraluminal impedance testing and disease-specific quality of life questionnaires now provide better insight into these problems and may contribute to better long-term outcomes in the future.
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Affiliation(s)
- Marinde van Lennep
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
| | - Maartje M J Singendonk
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
| | - Luigi Dall'Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy
| | - Fréderic Gottrand
- CHU Lille, University Lille, National Reference Center for Congenital Malformation of the Esophagus, Department of Pediatric Gastroenterology Hepatology and Nutrition, Lille, France
| | - Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne W J Terheggen-Lagro
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Pulmonology, Amsterdam, The Netherlands
| | - Taher I Omari
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Center for Neuroscience, Flinders University, Adelaide, South Australia, Australia
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands.
| | - Michiel P van Wijk
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Gastroenterology, Amsterdam, The Netherlands
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33
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Kause F, Zhang R, Ludwig M, Schmiedeke E, Rissmann A, Thiele H, Altmueller J, Herms S, Hilger AC, Hildebrandt F, Reutter H. HSPA6: A new autosomal recessive candidate gene for the VATER/VACTERL malformation spectrum. Birth Defects Res 2019; 111:591-597. [PMID: 30887706 DOI: 10.1002/bdr2.1493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/21/2019] [Accepted: 03/03/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The VATER/VACTERL association refers to the nonrandom co-occurrence of at least three of the following component features (CFs): vertebral defects (V), anorectal malformations (ARM) (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), renal malformations (R), and limb defects (L). Patients presenting with two CFs have been termed VATER/VACTERL-like phenotypes. METHODS We surveyed the exome for recessive disease variants in three affected sib-pairs. Sib-pair 971 consisted of two brothers with ARM and additional hydronephrosis in one brother. Sib-pair 1098 consisted of two sisters with ARM. In family 1346, the daughter presented with ARM and additional hypoplasia of both small fingers and ankyloses. Her brother presented with unilateral isolated radial hypoplasia. Sib-pairs 971 and 1346 resembled a VATER/VACTERL-like phenotype. RESULTS We detected a novel maternally inherited missense variant (c.1340G > T) and a rare paternally inherited deletion of the trans-allele in HSPA6 in both siblings of family 1346. HSPA6 belongs to the heat shock protein (HSP) 70 family. Re-sequencing of HSPA6 in 167 patients with VATER/VACTERL and VATER/VACTERL-like phenotypes did not reveal any additional bi-allelic variants. CONCLUSIONS Until now, only TNF-receptor associated protein 1 (TRAP1) had been reported as an autosomal recessive disease-gene for the VATER/VACTERL association. TRAP1 belongs to the heat shock protein 90 family (HSP90). Both Hsp70 and Hsp90 genes have been shown to be important embryonic drivers in the formation of mouse embryonic forelimb tissue. Our results suggest HSPA6 as a new candidate gene in VATER/VACTERL-like phenotypes.
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Affiliation(s)
- Franziska Kause
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Rong Zhang
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, Bonn, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Eberhard Schmiedeke
- Clinic for Paediatric Surgery and Paediatric Urology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Janine Altmueller
- Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Stefan Herms
- Department of Genomics, Life & Brain Center, Bonn, Germany.,Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, Human Genomics Research Group, University of Basel, Basel, Switzerland
| | - Alina C Hilger
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Children's Hospital, University of Bonn, Bonn, Germany
| | | | - Heiko Reutter
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
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Slagle CL, Schulz EV, Annibale DJ. VACTERL Association with Situs Inversus Totalis: A Unique Combination. Neonatal Netw 2019; 38:98-106. [PMID: 31470372 DOI: 10.1891/0730-0832.38.2.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT. IMPLICATIONS FOR PRACTICE Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.
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MESH Headings
- Aftercare/methods
- Anal Canal/abnormalities
- Anal Canal/physiopathology
- Diagnosis, Differential
- Esophagus/abnormalities
- Esophagus/physiopathology
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Humans
- Infant, Newborn
- Kidney/abnormalities
- Kidney/physiopathology
- Limb Deformities, Congenital/complications
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/physiopathology
- Limb Deformities, Congenital/therapy
- Neonatal Screening/methods
- Patient Care Management/methods
- Physical Examination/methods
- Radiography, Abdominal/methods
- Radiography, Thoracic/methods
- Respiratory Distress Syndrome, Newborn/diagnosis
- Situs Inversus/complications
- Situs Inversus/diagnosis
- Situs Inversus/physiopathology
- Situs Inversus/therapy
- Spine/abnormalities
- Spine/physiopathology
- Trachea/abnormalities
- Trachea/physiopathology
- Vestibulocochlear Nerve Diseases/congenital
- Vestibulocochlear Nerve Diseases/diagnosis
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35
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Santos LP, Coimbra D, Cunha C, Lopes MF. Oesophageal atresia with tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease: outcome of a rare phenotype. BMJ Case Rep 2019; 12:12/2/e226675. [PMID: 30798270 DOI: 10.1136/bcr-2018-226675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Oesophageal atresia with or without tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease are surgical malformations of the gastrointestinal tract typically diagnosed early in the neonatal period and varying in severity and prognosis. This report describes a full-term male newborn presenting simultaneous oesophageal atresia with distal tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease. In addition to the complex types of gastrointestinal malformations involved, the combination of ileal atresia and Hirschsprung's disease, as well as ganglion cells distal to intestinal atresia, resulted in a challenging diagnosis. Despite a successful outcome, the patient presented increased morbidity and prolonged hospitalisation. We highlight some important findings that may aid the early diagnosis of Hirschsprung's disease in this clinical setting. To our knowledge, the association of oesophageal atresia/tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease has not been previously reported.
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Affiliation(s)
- Liliana Pimenta Santos
- Department of Paediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Diana Coimbra
- Department of Paediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Catarina Cunha
- Department of Paediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Maria Francelina Lopes
- Department of Paediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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36
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Vergouwe FWT, Vlot J, IJsselstijn H, Spaander MCW, van Rosmalen J, Oomen MWN, Hulscher JBF, Dirix M, Bruno MJ, Schurink M, Wijnen RMH. Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study. Arch Dis Child 2019; 104:152-157. [PMID: 30007949 DOI: 10.1136/archdischild-2017-314710] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/15/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures. METHODS Retrospective national multicentre study in patients with OA born between 1999 and 2013. Exclusion criteria were isolated fistula, inability to obtain oesophageal continuity, death prior to discharge and follow-up <6 months. A refractory oesophageal stricture was defined as an anastomotic stricture requiring ≥5 dilations at maximally 4-week intervals. Risk factors for development of refractory anastomotic strictures after OA repair were identified with multivariable logistic regression analysis. RESULTS We included 454 children (61% male, 7% isolated OA (Gross type A)). End-to-end anastomosis was performed in 436 (96%) children. Anastomotic leakage occurred in 13%. Fifty-eight per cent of children with an end-to-end anastomosis developed an anastomotic stricture, requiring a median of 3 (range 1-34) dilations. Refractory strictures were found in 32/436 (7%) children and required a median of 10 (range 5-34) dilations. Isolated OA (OR 5.7; p=0.012), anastomotic leakage (OR 5.0; p=0.001) and the need for oesophageal dilation ≤28 days after anastomosis (OR 15.9; p<0.001) were risk factors for development of a refractory stricture. CONCLUSIONS The incidence of refractory strictures of the end-to-end anastomosis in children treated for OA was 7%. Risk factors were isolated OA, anastomotic leakage and the need for oesophageal dilation less than 1 month after OA repair.
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Affiliation(s)
- Floor W T Vergouwe
- Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - John Vlot
- Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Matthijs W N Oomen
- Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam (Academic Medical Center and VU Medical Center), Amsterdam, The Netherlands
| | - Jan B F Hulscher
- Department of Paediatric Surgery, University Medical Center Groningen-Beatrix Children's Hospital, Groningen, The Netherlands
| | - Marc Dirix
- Department of Paediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten Schurink
- Department of Paediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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Solomon BD. The etiology of VACTERL association: Current knowledge and hypotheses. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:440-446. [DOI: 10.1002/ajmg.c.31664] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
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38
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Veras LV, Smith JR, Gosain A. Lack of disparities in screening for associated anomalies in children with anorectal malformations. J Surg Res 2018; 231:10-14. [PMID: 30278916 DOI: 10.1016/j.jss.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with anorectal malformations (ARM) often have associated congenital anomalies and should undergo several screening exams in the first year of life. We hypothesized that racial and socioeconomic disparities exist in the screening processes for these patients. METHODS After IRB approval, a retrospective review of patients with ARM born between 2005 and 2016 was performed at a quaternary care children's hospital. Demographics including gender, race, insurance, and zip code were collected. Zip code was used as a surrogate for median income. Chart review was performed to identify anomaly type and whether Vertebral defects, Anorectal malformations, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities screening was performed within 1 y of age. Descriptive statistics and chi square analyses were performed. RESULTS One hundred patients (59% male, 68% low malformation) were identified. African American and Caucasian subjects represented 41% and 40% of the population, respectively. Overall, 68 of 100 patients had at least one screening test for each of the Vertebral defects, Anorectal malformations, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities associations. Although some minor differences were noted (more African Americans received skeletal survey than Caucasians, 80.5% versus 60%, P = 0.00335), no pattern of systematic bias in the receipt or timing of screening was evident based on race, insurance, or income. CONCLUSIONS There do not appear to be racial or socioeconomic disparities in screening for associated anomalies in patients with ARM. However, overall gaps in screening still exist, and work must be carried out to appropriately screen all patients for associated anomalies.
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Affiliation(s)
- Laura V Veras
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Justin R Smith
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.
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Abstract
RATIONALE The clinical manifestations of VACTERL association include vertebral anomalies, anal atresia, congenital heart diseases, tracheoesophageal fistula, renal dysplasia, and limb abnormalities. The association of intrahepatic anomalies and VACTERL syndrome is a rare coincidence. VACTER syndrome and intrahepatic bile drainage anomalies might be genetically related. PATIENT CONCERNS A 12-year-old girl presented with episodic colicky abdominal pain, nausea, and vomiting for several years. The individual episodes resolved spontaneously within a few days. She had a history of VACTERL syndrome, including a butterfly shape of the L3 vertebra, anal atresia, and an atrial septal defect. DIAGNOSES On laboratory findings, abnormal liver function tests included elevated total bilirubin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase. There was no significant abnormal finding in hepatobiliary system sonography except mild gallbladder wall thickening. We performed magnetic resonance cholangiopancreatography and demonstrated an abnormal intrahepatic bile duct confluence, which showed 3 bile ducts draining directly into the neck of the gallbladder. INTERVENTION Her symptoms related to bile reflux during gallbladder contraction. Cholecystectomy with choledochojejunostomy was undertaken because segments of the bile drainage were intertwined. OUTCOMES After surgery, her symptoms decreased, but abdominal discomfort remained due to uncorrected left intrahepatic anomalies. LESSONS Although hepatobiliary anomalies are not included in VACTERL association diagnostic criteria, detailed hepatobiliary work up is needed when gastrointestinal symptoms are present in VACTERL association patients.
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Affiliation(s)
| | | | - Suk Keu Yeom
- Department of Radiology, College of Medicine, Korea University, Seoul
- Department of Radiology
| | - JeeHyun Lee
- Department of Pediatrics
- Department of Pediatrics, Korea University Medical Center Ansan Hospital, Korea
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40
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Minneci PC, Kabre RS, Mak GZ, Halleran DR, Cooper JN, Afrazi A, Calkins CM, Downard CD, Ehrlich P, Fraser J, Gadepalli SK, Helmrath MA, Kohler JE, Landisch R, Landman MP, Lee C, Leys CM, Lodwick DL, Mon R, McClure B, Rymeski B, Saito JM, Sato TT, St Peter SD, Wood R, Levitt MA, Deans KJ. Screening practices and associated anomalies in infants with anorectal malformations: Results from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2018; 53:1163-1167. [PMID: 29602552 DOI: 10.1016/j.jpedsurg.2018.02.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates screening practices and the incidence of associated anomalies in infants with anorectal malformations (ARM). METHODS We performed a multi-institutional retrospective cohort study of children born between 2007 and 2011 who underwent surgery for ARM at 10 children's hospitals. ARM type was classified based on the location of the distal rectum, and all screening studies were reviewed. RESULTS Among 506 patients, the most common ARM subtypes were perineal fistula (40.7%), no fistula (11.5%), and vestibular fistula (10.1%). At least 1 screening test was performed in 96.6% of patients, and 11.3% of patients underwent all. The proportion of patients with ≥1 abnormal finding on any screening test varied by type of ARM (p<0.001). Screening rates varied from 15.2% for limb anomalies to 89.7% for renal anomalies. The most commonly identified anomalies by screening category were: spinal: tethered cord (20.6%); vertebral: sacral dysplasia/hemisacrum (17.8%); cardiac: patent foramen ovale (58.0%); renal: hydronephrosis (22.7%); limb: absent radius (7.9%). CONCLUSION Screening practices and the incidence of associated anomalies varied by type of ARM. The rate of identifying at least one associated anomaly was high across all ARM subtypes. Screening for associated anomalies should be considered standard of care for all ARM patients. TYPE OF STUDY Multi-institutional retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter C Minneci
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
| | - Rashmi S Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Devin R Halleran
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Amin Afrazi
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Casey M Calkins
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rachel Landisch
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Constance Lee
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Daniel L Lodwick
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Rodrigo Mon
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Beth McClure
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Beth Rymeski
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Richard Wood
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
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Vergouwe FWT, Gottrand M, Wijnhoven BPL, IJsselstijn H, Piessen G, Bruno MJ, Wijnen RMH, Spaander MCW. Four cancer cases after esophageal atresia repair: Time to start screening the upper gastrointestinal tract. World J Gastroenterol 2018; 24:1056-1062. [PMID: 29531469 PMCID: PMC5840470 DOI: 10.3748/wjg.v24.i9.1056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 02/06/2023] Open
Abstract
Esophageal atresia (EA) is one of the most common congenital digestive malformations and requires surgical correction early in life. Dedicated centers have reported survival rates up to 95%. The most frequent comorbidities after EA repair are dysphagia (72%) and gastroesophageal reflux (GER) (67%). Chronic GER after EA repair might lead to mucosal damage, esophageal stricturing, Barrett’s esophagus and eventually esophageal adenocarcinoma. Several long-term follow-up studies found an increased risk of Barrett’s esophagus and esophageal carcinoma in EA patients, both at a relatively young age. Given these findings, the recent ESPGHAN-NASPGHAN guideline recommends routine endoscopy in adults born with EA. We report a series of four EA patients who developed a carcinoma of the gastrointestinal tract: three esophageal carcinoma and one colorectal carcinoma in a colonic interposition. These cases emphasize the importance of lifelong screening of the upper gastrointestinal tract in EA patients.
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Affiliation(s)
- Floor WT Vergouwe
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam 3000 CA, Netherlands
- Department of Pediatric Surgery, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam 3000 CB, Netherlands
| | - Madeleine Gottrand
- Department of Pediatrics, Jeanne de Flandre Children’s Hospital - Univ. Lille, CHU Lille, Lille 59000, France
| | - Bas PL Wijnhoven
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3000 CA, Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam 3000 CB, Netherlands
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital - Univ. Lille, CHU Lille, Lille 59000, France
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam 3000 CA, Netherlands
| | - René MH Wijnen
- Department of Pediatric Surgery, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam 3000 CB, Netherlands
| | - Manon CW Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam 3000 CA, Netherlands
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Challenges in Transition of Care for Patients With Anorectal Malformations: A Systematic Review and Recommendations for Comprehensive Care. Dis Colon Rectum 2018; 61:390-399. [PMID: 29420431 DOI: 10.1097/dcr.0000000000001033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anorectal malformations are one of the most common congenital intestinal anomalies affecting newborns. Despite advances in neonatal care and surgical techniques, many patients with a history of anorectal malformations are affected by long-term challenges involving bowel and bladder dysfunction, sexual dysfunction, and psychosocial issues. These outcomes or challenges are additionally exacerbated by the lack of a structured transition of care from the pediatric to the adult setting. OBJECTIVE The purpose of this review is to describe the long-term outcomes affecting patients with a history of anorectal malformations, review the current literature on transition of care, and make recommendations for developing a standardized program for transitioning care for a select group of colorectal surgical patients. DATA SOURCES An extensive PubMed review of articles in English was performed to evaluate current best practices for chronic illnesses of childhood with residual symptoms or need for medical care into adulthood. STUDY SELECTION Meta-Analysis of Observational Studies in Epidemiology group guidelines were followed. MAIN OUTCOME MEASURES The primary outcome for this review was the existence of transitional services for patients with a history of anorectal malformations and evaluations of long-term outcomes affecting patients with a history of anorectal malformations. RESULTS Systematic review revealed improved results in transition programs as determined by patient follow-up, medication adherence, and patient and family satisfaction through the use of multidisciplinary teams. Standardized tools for assessing all aspects of patient outcomes and quality of life are essential for describing the burden of disease affecting a transitioning population. LIMITATIONS This is a retrospective review of the current status of a complex and rapidly evolving field of delivery of care. More work is needed to apply uniform approaches and assess the impact, patient outcomes, and quality of life. CONCLUSIONS Patients who undergo childhood procedures for anorectal malformations often experience chronic symptoms related to the bowel, bladder, and reproductive organs, as well as psychosocial disturbances. This population will benefit from appropriate engagement in transitional care plans. See Video Abstract at http://links.lww.com/DCR/A543.
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Abstract
BACKGROUND Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity. PURPOSE Timely management of the neonate can greatly impact the infant's overall outcome. Spreading latest evidence-based knowledge and sharing practical experience with clinicians across various levels of the neonatal intensive care unit and well-baby units have the potential to decrease the rate of morbidity and mortality. METHODS/SEARCH STRATEGY PubMed, CINAHL, Cochrane Review, and Google Scholar were used to search key words- tracheoesophageal fistula, esophageal atresia, TEF/EA, VACTERL, long gap, post-operative management, NICU, pediatric surgery-for articles that were relevant and current. FINDINGS/RESULTS Advancements in both technology and medicine have helped identify and decrease postsurgical complications. More understanding and clarity are needed to manage acid suppression and its effects in a timely way. IMPLICATIONS FOR PRACTICE Knowing the clinical signs of potential TEF/EA, clinicians can initiate preoperative management and expedite transfer to a hospital with pediatric surgeons who are experts in TEF/EA management to prevent long-term morbidity. IMPLICATIONS FOR RESEARCH Various methods of perioperative management exist, and future studies should look into standardizing perioperative care. Other areas of research should include acid suppression recommendation, reducing long-term morbidity seen in patients with TEF/EA, postoperative complications, and how we can safely and effectively decrease the length of time to surgery for long-gap atresia in neonates.
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Abstract
Imperforate anus, a variant of anorectal malformation (ARM), is a common congenital anomaly requiring surgical attention in the newborn period. It may present with a variety of anatomic configurations, largely dependent on the presence and location of a fistula. The location (or characteristics) of a fistula, which usually lies between the gastrointestinal tract and the genitourinary tract or perineum, is often used in determining the type and timing of operative management. This article discusses the work-up and management, modes of treatment and their postoperative outcomes, and continued controversy regarding the use of minimally invasive surgical approaches to ARM.
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Anorectal malformations, associated congenital anomalies and their investigation in a South African setting. Pediatr Surg Int 2017; 33:875-882. [PMID: 28612139 DOI: 10.1007/s00383-017-4109-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE This study was undertaken to investigate the types of anorectal malformations (ARM), incidence of associated abnormalities and investigative methods used in patients treated at Red Cross War Memorial Children's Hospital and to determine whether these are in keeping with recent literature. Mortality rates were also reviewed. METHODS A retrospective review of patients with ARM between 1993 and 2016 was undertaken. Clinical notes were reviewed and correlated with radiology and cardiac databases. Abnormalities were grouped according to genitourinary, musculoskeletal, gastrointestinal and cardiovascular systems. The data were separated into three periods to ascertain whether the workup strategy had changed over the years. RESULTS A total of 282 patients were included. There were 134 (47.5%) high and 116 (41.1%) low lesions and unspecified in 32 (11.3%) patients. There were 59 (20.9%) vestibular fistulae, 46 (16.3%) combined rectourethral fistulae (rectoprostatic, rectobulbar and unspecified rectourethral) and 42 (14.9%) perineal fistulae. Associated abnormalities were detected in 152/221 (69%). Abnormalities were: Genitourinary 88/204 (43.1%), musculoskeletal 80/188 (42.5%), cardiac 44/218 (20.1%) and gastrointestinal 12/216 (5.6%). Twenty patients demised. CONCLUSION Vestibular fistulae were most common followed by rectourethral and perineal fistulae. Musculoskeletal and genitourinary abnormalities were the most common associated findings. The mortality rate was 7% and cardiac lesions contributed to mortality. As knowledge of ARM improved, so has awareness of associated malformations. This has led to improved, more active workup, in keeping with the latest literature.
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Zhang R, Marsch F, Kause F, Degenhardt F, Schmiedeke E, Märzheuser S, Hoppe B, Bachour H, Boemers TM, Schäfer M, Spychalski N, Neser J, Leonhardt J, Kosch F, Ure B, Gómez B, Lacher M, Deffaa OJ, Palta M, Wittekindt B, Kleine K, Schmedding A, Grasshoff-Derr S, Ven AVD, Heilmann-Heimbach S, Zwink N, Jenetzky E, Ludwig M, Reutter H. Array-based molecular karyotyping in 115 VATER/VACTERL and VATER/VACTERL-like patients identifies disease-causing copy number variations. Birth Defects Res 2017; 109:1063-1069. [DOI: 10.1002/bdr2.1042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/13/2017] [Accepted: 04/06/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Rong Zhang
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; Bonn Germany
| | - Florian Marsch
- Institute of Human Genetics; University of Bonn; Bonn Germany
| | - Franziska Kause
- Institute of Human Genetics; University of Bonn; Bonn Germany
| | - Franziska Degenhardt
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; Bonn Germany
| | - Eeberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Centre for Child and Youth Health; Klinikum Bremen-Mitte; Bremen Germany
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, Campus Virchow Clinic; Charité University Hospital Berlin; Berlin Germany
| | - Bernd Hoppe
- Department of Pediatrics; University Medical Center; Bonn Germany
| | - Haitham Bachour
- Department of Pediatric Surgery; University Hospital Bonn; Bonn Germany
| | - Thomas M. Boemers
- Department of Pediatric Surgery and Urology; University Hospital Cologne; Cologne Germany
| | - Matthias Schäfer
- Department of Pediatric Surgery and Urology; Cnopf'sche Kinderklinik; Nürnberg Germany
| | - Nicole Spychalski
- Department of Pediatric Surgery and Urology; Cnopf'sche Kinderklinik; Nürnberg Germany
| | - Jörg Neser
- Department of Pediatric Surgery; General Hospital; Chemnitz Germany
| | - Johannes Leonhardt
- Department of Pediatric Surgery; St. Bernward-Krankenhaus; Hildesheim Germany
| | - Ferdinand Kosch
- Department of Pediatric Surgery; Städtisches Klinikum Karlsruhe; Karlsruhe Germany
| | - Benno Ure
- Center of Pediatric Surgery Hannover; Hannover Medical School and Bult Children's Hospital; Hannover Germany
| | - Barbara Gómez
- Department of Pediatric Surgery; Children's and Youth Hospital “Auf der Bult”; Hannover Germany
| | - Martin Lacher
- Department of Pediatric Surgery; University of Leipzig; Leipzig Germany
| | - Oliver J. Deffaa
- Department of Pediatric Surgery; University of Leipzig; Leipzig Germany
| | - Markus Palta
- Department of Pediatric Surgery; Evangelisches Krankenhaus Hamm; Hamm Germany
| | - Boris Wittekindt
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Katharina Kleine
- Department of Pediatric Surgery; Evangelisches Krankenhaus Oberhausen; Germany
| | - Andrea Schmedding
- Department of Paediatric Surgery and Paediatric Urology; University Hospital of the Goethe-University Frankfurt/M; Frankfurt/M Germany
| | | | - Amelie van der Ven
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Medicine, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; Bonn Germany
| | - Nadine Zwink
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
- Department for Child and Adolescent Psychiatry; Johannes Gutenberg-University; Mainz Germany
- Child Centre Maulbronn; Hospital for Paediatric Neurology and Social Paediatrics; Maulbronn Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology; University of Bonn; Bonn Germany
| | - Heiko Reutter
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; Bonn Germany
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital; University of Bonn; Bonn Germany
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Lane VA, Ambeba E, Chisolm DJ, Lodwick D, Levitt MA, Wood RJ, Deans KJ, Minneci PC. Low vertebral ano-rectal cardiac tracheo-esophageal renal limb screening rates in children with anorectal malformations. J Surg Res 2016; 203:398-406. [DOI: 10.1016/j.jss.2016.03.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/03/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Hong CS, Wang AC, Bonow RH, Abecassis IJ, Amlie-Lefond C, Ellenbogen RG. Moyamoya Disease in a Patient with VACTERL Association. World Neurosurg 2016; 89:729.e7-729.e10. [DOI: 10.1016/j.wneu.2016.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
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Chen Y, Liu Z, Chen J, Zuo Y, Liu S, Chen W, Liu G, Qiu G, Giampietro PF, Wu N, Wu Z. The genetic landscape and clinical implications of vertebral anomalies in VACTERL association. J Med Genet 2016; 53:431-7. [PMID: 27084730 PMCID: PMC4941148 DOI: 10.1136/jmedgenet-2015-103554] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/17/2016] [Indexed: 01/22/2023]
Abstract
VACTERL association is a condition comprising multisystem congenital malformations, causing severe physical disability in affected individuals. It is typically defined by the concurrence of at least three of the following component features: vertebral anomalies (V), anal atresia (A), cardiac malformations (C), tracheo-oesophageal fistula (TE), renal dysplasia (R) and limb abnormalities (L). Vertebral anomaly is one of the most important and common defects that has been reported in approximately 60–95% of all VACTERL patients. Recent breakthroughs have suggested that genetic factors play an important role in VACTERL association, especially in those with vertebral phenotypes. In this review, we summarised the genetic studies of the VACTERL association, especially focusing on the genetic aetiology of patients with vertebral anomalies. Furthermore, genetic reports of other syndromes with vertebral phenotypes overlapping with VACTERL association are also included. We aim to provide a further understanding of the genetic aetiology and a better evidence for genetic diagnosis of the association and vertebral anomalies.
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Affiliation(s)
- Yixin Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenlei Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuzhi Zuo
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sen Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
| | - Weisheng Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Gang Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
| | - Philip F Giampietro
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
| | - Zhihong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Velazquez D, Pereira E, Havranek T. Neonate with VACTERL Association and a Branchial Arch Anomaly without Hydrocephalus. AJP Rep 2016; 6:e74-6. [PMID: 26929876 PMCID: PMC4737631 DOI: 10.1055/s-0035-1566297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/29/2015] [Indexed: 10/30/2022] Open
Abstract
VACTERL (vertebral anomalies, anal atresia, cardiac defect, tracheoesophageal fistula, renal anomaly, limb anomalies) is an association of anomalies with a wide spectrum of phenotypic expression. While the majority of cases are sporadic, there is evidence of an inherited component in a small number of patients as well as the potential influence of nongenetic risk factors (maternal diabetes mellitus). Presence of hydrocephalus has been reported in VACTERL patients (VACTERL-H) in the past, with some displaying branchial arch anomalies. We report the unique case of an infant of diabetic mother with VACTERL association and a branchial arch anomaly-in the absence of hydrocephalus.
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Affiliation(s)
- Danitza Velazquez
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Elaine Pereira
- Division of Genetics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Thomas Havranek
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
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