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Zouari M, Ameur HB, Krichen E, Saad NB, Dhaou MB, Mhiri R. Risk factors for adverse outcomes following surgical repair of esophageal atresia. A retrospective cohort study. Dis Esophagus 2023; 36:doac070. [PMID: 36214334 DOI: 10.1093/dote/doac070] [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: 06/28/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Esophageal atresia (EA) is a life-threatening congenital malformation of the esophagus. Despite considerable recent advances in perinatal resuscitation and neonatal care, EA remains an important cause of mortality and morbidity, especially in low-income countries. The aim of this study was to assess risk factors for adverse outcomes following surgical repair of EA at a single center in Tunisia. We performed a retrospective analysis using medical records of neonates with surgical management of EA at our institution from 1 January 2007 to 31 December 2021. In total, 88 neonates were included with a mortality rate of 25%. There were 29 girls and 59 boys. The diagnosis of EA was suspected prenatally in 19 patients. The most common associated anomalies were congenital heart diseases. Prematurity, low birth weight, outborn birth, age at admission >12 hours, congenital heart disease, postoperative sepsis, and anastomotic leak were risk factors for mortality following surgical repair of EA. Anastomotic tension was the only factor associated with short-term complications and the occurrence of short-term complications was predictive of mid-term complications. This study provides physicians and families with contemporary information regarding risk factors for adverse outcomes following surgical repair of EA. Thus, any effort to reduce these risk factors would be critical to improving patient outcomes and reducing cost. Future multi-institutional studies are needed to identify, investigate, and establish best practices and clinical care guidelines for neonates with EA.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nesrine Ben Saad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Newland N, Snajdauf J, Kokesova A, Styblova J, Hradsky O, Meusel I, Kucerova B, Kyncl M, Simsova M, Mixa V, Rygl M. Anastomotic stricture prediction in patients with esophageal atresia with distal fistula. Pediatr Surg Int 2023; 39:136. [PMID: 36811679 PMCID: PMC9947071 DOI: 10.1007/s00383-023-05423-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate potential early risk factors for anastomotic stricture formation and assess the predictive role of post-operative esophagrams. METHODS A retrospective study of patients with esophageal atresia with distal fistula (EA/TEF) operated between 2011 and 2020. Fourteen predictive factors were tested for stricture development. Esophagrams were used to calculate early (SI1) and late (SI2) stricture index (SI = anastomosis diameter/upper pouch diameter). RESULTS Of 185 patients operated for EA/TEF in the 10-year period, 169 patients met the inclusion criteria. Primary anastomosis was performed in 130 patients and delayed anastomosis in 39 patients. Stricture formed in 55 patients (33%) within 1 year from anastomosis. Four risk factors showed strong association with stricture formation in unadjusted models: long gap (p = 0.007), delayed anastomosis (p = 0.042), SI1 (p = 0.013) and SI2 (p < 0.001). A multivariate analysis showed SI1 as significantly predictive of stricture formation (p = 0.035). Cut-off values using a receiver operating characteristic (ROC) curve were 0.275 for SI1 and 0.390 for SI2. The area under the ROC curve demonstrated increasing predictiveness from SI1 (AUC 0.641) to SI2 (AUC 0.877). CONCLUSIONS This study identified an association between long gap and delayed anastomosis with stricture formation. Early and late stricture indices were predictive of stricture formation.
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Affiliation(s)
- Natalia Newland
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Jiri Snajdauf
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Alena Kokesova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jitka Styblova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Hradsky
- Department of Pediatric Gastroenterology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Isabel Meusel
- Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Magdalena Simsova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir Mixa
- Department of Anesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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Misganaw NM, Sebsbie G, Adimasu M, Getaneh FB, Arage G, GebreEyesus FA, Bayih WA, Chanie ES, Bantie B, Kerebeh G, Birhanu D, Jemere T, Mengist A, Kassaw A. Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia. J Multidiscip Healthc 2022; 15:1225-1235. [PMID: 35669446 PMCID: PMC9166279 DOI: 10.2147/jmdh.s366470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background Esophageal atresia is an upper gastrointestinal tract developmental abnormality in which the upper and lower esophagus do not connect. Esophageal atresia has a higher incidence of death in sub-Saharan Africa, ranging from 30% to 80%. In Ethiopia, infants with esophageal atresia had a higher mortality rate. The assessment of time to death and predictors of esophageal atresia can help to reduce newborn mortality. Objective This study was aimed to investigate the time to death and predictors of neonates with esophageal atresia admitted to Tikur Anbessa Specialized Hospital, Ethiopia. Methods An institutional-based retrospective follow-up study was conducted among 225 neonates diagnosed with esophageal atresia. The median survival time, Kaplan–Meier failure estimation curve, and Log rank test were computed. Bivariable and multivariable Cox regression hazards models were fitted to identify the predictors of time to death. Hazard ratio with a 95% confidence interval was calculated and p-values <0.05 were considered statistically significant. Results In the study, the incidence density rate of neonates diagnosed with esophageal atresia was 5.5 (95% CI, 4.7–6.4) per 100-neonates day. The median time to death was 11 days (95% confidence interval (CI), 8.92–13.08). Birth weight <2500 g (adjusted hazard ratio (AHR)=1.49, 95% CI, 1.02 −2.21), having sepsis (AHR=1.67,95% CI, 1.15–2.44), being malnourished (AHR = 1.61, 95% CI, 1.03 −2.58), esophageal atretic neonates without surgery (AHR = 3.72, 95% CI, 1.34–10.38), diagnosis time at >48 hours of admission (AHR = 1.48, 95% CI, 1.01–2.15) and being dehydrated (AHR = 2.38, 95% CI, 1.63–3.46) were significant predictors of time to death among esophageal atretic neonates. Conclusion The findings in this study highlighted the necessity of early diagnosis, proper comorbidity treatment, and timely surgical intervention to reduce infant deaths due to esophageal atresia.
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Affiliation(s)
- Natnael Moges Misganaw
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
- Correspondence: Natnael Moges Misganaw, Email
| | - Girum Sebsbie
- Addis Ababa University, College of Health Science, School of Nursing and Midwifery, Department of Paediatrics and Child Health Nursing, Addis Ababa, Ethiopia
| | - Mekonen Adimasu
- Addis Ababa University, College of Health Science, School of Nursing and Midwifery, Department of Paediatrics and Child Health Nursing, Addis Ababa, Ethiopia
| | - Fekadeselassie Belege Getaneh
- Wollo University, College of Health Science, School of Nursing and Midwifery, Department of Paediatrics and Child Health Nursing, Dessie, Ethiopia
| | - Getachew Arage
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
| | - Fisha Alebel GebreEyesus
- Wolkite University, College of Medicine and Health Science, Department of Paediatrics and Child Health Nursing, Wolkite, Ethiopia
| | - Wubet Alebachew Bayih
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Debre Tabor University, College of Health Science, Department of Adult Health Nursing, Debre Tabor, Ethiopia
| | - Gashaw Kerebeh
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
| | - Dires Birhanu
- Dilla University, College of Health Science, Department of Paediatrics and Child Health Nursing, Dilla, Ethiopia
| | - Tadeg Jemere
- Debre Tabor University, College of Health Science, Department of Biomedical Science, Debre Tabor, Ethiopia
| | - Anteneh Mengist
- Debre Tabor University, College of Health Science, Department of Public Health, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Debre Tabor University, College of Health Science, Department of Paediatrics and Child Health Nursing, Debre Tabor, Ethiopia
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Ladefoged MR, Korang SK, Hildorf SE, Oehlenschlæger J, Poulsen S, Fossum M, Lausten-Thomsen U. Necessity of Prophylactic Extrapleural Chest Tube During Primary Surgical Repair of Esophageal Atresia: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:849992. [PMID: 35372168 PMCID: PMC8971748 DOI: 10.3389/fped.2022.849992] [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: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Esophageal atresia is corrected surgically by anastomosing and recreating esophageal continuity. To allow the removal of excess fluid and air from the anastomosis, a prophylactic and temporary intraoperative chest tube (IOCT) has traditionally been placed in this area during surgery. However, whether the potential benefits of this prophylactic IOCT overweigh the potential harms is unclear. Objective To assess the benefits and harms of using a prophylactic IOCT during primary surgical repair of esophageal atresia. Data Sources We conducted a systematic review with a meta-analysis. We searched Cochrane Central Register of Controlled Trials (2021, Issue 12), MEDLINE Ovid, Embase Ovid, CINAHL, and Science Citation Index Expanded and Conference Proceedings Citation Index-(Web of Science). Search was performed from inception until December 3rd, 2021. Study Selection Randomized clinical trials (RCT) assessing the effect of a prophylactic IOCT during primary surgical repair of esophageal atresia and observational studies identified during our searches for RCT. Data Extraction and Synthesis Two independent reviewers screened studies and performed data extraction. The certainty of the evidence was assessed by GRADE and ROBINS-I. PROSPERO Registration A protocol for this review has been registered on PROSPERO (CRD42021257834). Results We included three RCTs randomizing 162 neonates, all at overall "some risk of bias." The studies compared the placement of an IOCT vs. none. The meta-analysis did not identify any significant effect of profylacitic IOCT, as confidence intervals were compatible with no effect, but the analyses suggests that the placement of an IOCT might lead to an increase in all-cause mortality (RR 1.66, 95% CI 0.76-3.65; three trials), serious adverse events (RR 1.08, 95% CI 0.58-2.00; three trials), intervention-requiring pneumothorax (RR 1.65, 95% CI 0.28-9.50; two trials), and anastomosis leakage (RR 1.66, 95% CI 0.63-4.40). None of our included studies assessed esophageal stricture or pain. Certainty of evidence was very low for all outcomes. Conclusions Evidence from RCTs does not support the routine use of a prophylactic IOCT during primary surgical repair of esophageal atresia.
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Affiliation(s)
- Martin Riis Ladefoged
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Anesthesiology Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, CA, United States
| | - Simone Engmann Hildorf
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jacob Oehlenschlæger
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Poulsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magdalena Fossum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Lausten-Thomsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Lejeune S, Sfeir R, Rousseau V, Bonnard A, Gelas T, Aumar M, Panait N, Rabattu PY, Irtan S, Fouquet V, Le Mandat A, Cocci SDN, Habonimana E, Lamireau T, Lemelle JL, Elbaz F, Talon I, Boudaoud N, Allal H, Buisson P, Petit T, Sapin E, Lardy H, Schmitt F, Levard G, Scalabre A, Michel JL, Jaby O, Pelatan C, De Vries P, Borderon C, Fourcade L, Breaud J, Arnould M, Tolg C, Chaussy Y, Geiss S, Laplace C, Drumez E, El Mourad S, Thumerelle C, Gottrand F. Esophageal Atresia and Respiratory Morbidity. Pediatrics 2021; 148:peds.2020-049778. [PMID: 34413249 DOI: 10.1542/peds.2020-049778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Respiratory diseases are common in children with esophageal atresia (EA), leading to increased morbidity and mortality in the first year. The primary study objective was to identify the factors associated with readmissions for respiratory causes in the first year in EA children. METHODS A population-based study. We included all children born between 2008 and 2016 with available data and analyzed factors at birth and 1 year follow-up. Factors with a P value <.10 in univariate analyses were retained in logistic regression models. RESULTS Among 1460 patients born with EA, 97 (7%) were deceased before the age of 1 year, and follow-up data were available for 1287 patients, who constituted our study population. EAs were Ladd classification type III or IV in 89%, preterm birth was observed in 38%, and associated malformations were observed in 52%. Collectively, 61% were readmitted after initial discharge in the first year, 31% for a respiratory cause. Among these, respiratory infections occurred in 64%, and 35% received a respiratory treatment. In logistic regression models, factors associated with readmission for a respiratory cause were recurrence of tracheoesophageal fistula, aortopexy, antireflux surgery, and tube feeding; factors associated with respiratory treatment were male sex and laryngeal cleft. CONCLUSIONS Respiratory morbidity in the first year after EA repair is frequent, accounting for >50% of readmissions. Identifying high risk groups of EA patients (ie, those with chronic aspiration, anomalies of the respiratory tract, and need for tube feeding) may guide follow-up strategies.
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Affiliation(s)
- Stéphanie Lejeune
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | - Rony Sfeir
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | | | | | | | - Madeleine Aumar
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | | | | | - Sabine Irtan
- University Hospital Armand Trousseau, Paris-Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Centre de Recherche St Antoine Inserm UMRS.938, Paris, France
| | | | | | | | | | | | | | | | | | | | - Hossein Allal
- University Hospital of Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | - Corinne Borderon
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Cécilia Tolg
- University Hospital of Fort de France, Martinique, France
| | - Yann Chaussy
- University Hospital of Besançon, Besançon, France
| | | | | | - Elodie Drumez
- METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales.,Department of Biostatistics, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Sawsan El Mourad
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille.,General Hospital of Arras, Arras, France
| | - Caroline Thumerelle
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | - Frédéric Gottrand
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
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Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study. J Pediatr 2021; 234:99-105.e1. [PMID: 33667507 DOI: 10.1016/j.jpeds.2021.02.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia (EA)-tracheoesophageal fistula. STUDY DESIGN Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1 year of age as a proxy measure of morbidity, and complications during the first year of life. RESULTS In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3 months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight (OR 0.52, 95% CI [0.38-0.72], P < .001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08-8.08], P = .034). LoS was associated with low birth weight (-0.225 ± 0.035, P < .001), associated malformations (0.082 ± 0.118, P < .001), surgical difficulties (0.270 ± 0.107, P < .001), and complications (0.535 ± 0.099, P < .001) during the first year of life. Predictive factors for dependency on nutrition support at 1 year of age were complications before 1 year (OR 3.28 [1.23-8.76], P < .02) and initial hospital LoS (OR 1.96 [1.15-3.33], P < .01). CONCLUSIONS EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population.
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Tan Tanny SP, Beck C, King SK, Hawley A, Brooks JA, McLeod E, Hutson JM, Teague WJ. Survival Trends and Syndromic Esophageal Atresia. Pediatrics 2021; 147:peds.2020-029884. [PMID: 33911029 DOI: 10.1542/peds.2020-029884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Presence of a syndrome (or association) is predictive of poor survival in esophageal atresia (EA). However, most reports rely on historical patient outcomes, limiting their usefulness when estimating risk for neonates born today. We hypothesized improved syndromic EA survival due to advances in neonatal care. METHODS A retrospective single-center review of survival in 626 consecutive patients with EA from 1980 to 2017 was performed. Data were collected for recognized risk factors: preterm delivery; birth weight <1500 g; major cardiac disease; vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities (VACTERL); and non-VACTERL syndromes. Cox proportional hazards regression models were used to evaluate temporal trends in survival with respect to year of birth and syndromic EA. RESULTS Overall, 87% of 626 patients with EA survived, ranging from 82% in the 1980s to 91% in the 2010s. After adjusting for confounders, syndromic EA survival did not improve during the study, with no association found between year of birth and survival (hazard ratio [HR] 0.98, 95% confidence interval [CI]: 0.95-1.01). Aside from lethal non-VACTERL syndromes, patients with nonlethal non-VACTERL syndromes (HR 6.85, 95% CI: 3.50-13.41) and VACTERL syndrome (HR 3.02, 95% CI: 1.66-5.49) had a higher risk of death than those with nonsyndromic EA. CONCLUSIONS Survival of patients with syndromic EA has not improved, and patients with non-VACTERL syndromes have the highest risk of death. Importantly, this is independent of syndrome lethality, birth weight, and cardiac disease. This contemporary survival assessment will enable more accurate perinatal counseling of parents of patients with syndromic EA.
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Affiliation(s)
- Sharman P Tan Tanny
- Departments of Paediatric Surgery.,Surgical Research Group and.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Sebastian K King
- Departments of Paediatric Surgery.,Surgical Research Group and.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Alisa Hawley
- Departments of Paediatric Surgery.,Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Australia; and
| | - Jo-Anne Brooks
- Departments of Paediatric Surgery.,Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Australia; and.,Neonatal Medicine, and
| | | | - John M Hutson
- Departments of Paediatric Surgery.,Surgical Research Group and.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Urology, The Royal Children's Hospital, Melbourne, Australia
| | - Warwick J Teague
- Departments of Paediatric Surgery, .,Surgical Research Group and.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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