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Wolfe C, Jnah A. Tracheoesophageal Fistula With Esophageal Atresia: A Case Series. Neonatal Netw 2024; 43:65-75. [PMID: 38599775 DOI: 10.1891/nn-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.
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2
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Mohammed S, Kamran A, Izadi S, Visner G, Frain L, Demehri FR, Shieh HF, Jennings RW, Smithers CJ, Zendejas B. Primary Posterior Tracheopexy at Time of Esophageal Atresia Repair Significantly Reduces Respiratory Morbidity. J Pediatr Surg 2024; 59:10-17. [PMID: 37903674 DOI: 10.1016/j.jpedsurg.2023.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Esophageal atresia with tracheoesophageal fistula (EA/TEF) is often associated with tracheobronchomalacia (TBM), which contributes to respiratory morbidity. Posterior tracheopexy (PT) is an established technique to treat TBM that develops after EA/TEF repair. This study evaluates the impact of primary PT at the time of initial EA/TEF repair. METHODS Review of all newborn primary EA/TEF repairs (2016-2021) at two institutions. Long-gap EA and reoperative cases were excluded. Based on surgeon preference and preoperative bronchoscopy, neonates underwent primary PT (EA + PT Group) or not (EA Group). Perioperative, respiratory and nutritional outcomes within the first year of life were evaluated. RESULTS Among 63 neonates, 21 (33%) underwent PT during EA/TEF repair. Groups were similar in terms of demographics, approach, and complications. Neonates in the EA + PT Group were significantly less likely to have respiratory infections requiring hospitalization within the first year of life (0% vs 26%, p = 0.01) or blue spells (0% vs 19%, p = 0.04). Also, they demonstrated improved weight-for-age z scores at 12 months of age (0.24 vs -1.02, p < 0.001). Of the infants who did not undergo primary PT, 10 (24%) developed severe TBM symptoms and underwent tracheopexy during the first year of life, whereas no infant in the EA + PT Group needed additional airway surgery (p = 0.01). CONCLUSION Incorporation of posterior tracheopexy during newborn EA/TEF repair is associated with significantly reduced respiratory morbidity within the first year of life. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Gary Visner
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Leah Frain
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Charles J Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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3
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Parekh S, Ochotny R, Lazow SP, Ben-Ishay O, Aribindi V, Pluchinotta FR, Tworetzky W, Buchmiller TL, Peyvandi S, Moon-Grady AJ. High prevalence of left superior vena cava and congenital heart disease in patients with pre- and postnatally diagnosed esophageal atresia/tracheoesophageal fistula. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:439-440. [PMID: 36929674 DOI: 10.1002/uog.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- S Parekh
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - R Ochotny
- Department of Palliative Care, Akron Children's Hospital, Akron, OH, USA
| | - S P Lazow
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - O Ben-Ishay
- Department of General Surgery, Ramban Healthcare Campus, Haifa, Israel
| | - V Aribindi
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - W Tworetzky
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - T L Buchmiller
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - S Peyvandi
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
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4
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Donovan MR, Skirko J, Lee J, Scheffler P. Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States. Int J Pediatr Otorhinolaryngol 2023; 172:111643. [PMID: 37557023 DOI: 10.1016/j.ijporl.2023.111643] [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: 04/10/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Although rare, esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) can lead to severe morbidity and mortality. A known complication of EA and/or TEF repair is vocal fold motion impairment (VFMI). OBJECTIVE To characterize the prevalence of VFMI among repaired EA and/or TEF at a national level and to identify factors associated with in-patient mortality and common clinical endpoints in this population (tracheostomy and gastrostomy tube dependence). METHODS This is a retrospective cohort study of inpatient neonate admissions with EA and/or TEF in the 2016 Kids' Inpatient Database (KID). Patients with a history of EA and/or TEF were identified with ICD-10 codes. VFMI prevalence was assessed by observed frequencies and percentages. Clinical endpoints included gastrostomy (G-)tube placement, tracheostomy status, and inpatient mortality. Potential predictors of these three primary outcomes included cardiac anomalies, airway disorders, chromosomal anomalies, surgery within 24 h of admission, prematurity, and low birthweight (LBW). Chi-squared analysis was performed between each parameter and the primary outcomes. Significant associations (p-value<0.05) were further assessed with multivariate logistic regression. RESULTS Of 1062 neonates with history of EA and/or TEF, 24 (2.3%) had VFMI. Among this population, 27 patients underwent tracheostomies and 63 required G-tubes. There was a significantly higher likelihood of tracheostomy in patients with VFMI compared to patients without (16.7% versus 2.2%; p < 0.01). After multivariate analysis, birthweight less than 1.5 kg (BW < 1.5 kg; OR = 2.5, 95% CI: 1.03-6.10), extreme prematurity (OR = 7.5, 95% CI: 2.00-28.07), cardiac anomalies (OR = 1.8, 95% CI: 1.01-3.04) and chromosomal anomalies (OR = 4.2, 95% CI: 2.39-7.44) were significantly associated with in-hospital mortality. Bronchopulmonary dysplasia (BPD; OR = 4.7, 95% CI: 1.73-12.78) and BW < 1.5 kg (OR = 2.4, 95% CI: 1.05-5.49) were significant predictors for G-tube status. For tracheostomy, BPD (OR = 15.8, 95% CI: 4.70-52.83) and subglottic stenosis (SS, OR = 11.2, 95% CI: 1.85-68.02) remained significant predictors after multivariate regression. CONCLUSION The national prevalence of VFMI among neonates following EA and/or TEF repair was 2.3% and was associated with an increased likelihood of tracheostomy in the KID 2016. Significant predictors of in-hospital mortality were cardiac anomalies, chromosomal anomalies, extreme prematurity, and BW < 1.5 kg. BPD and SS were significant predictors of tracheostomy, and BPD and BW < 1.5 kg were significant predictors for G-tube requirements.
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Affiliation(s)
| | - Jonathan Skirko
- Department of Otolaryngology, The University of Arizona, Tucson, AZ, USA
| | - Justin Lee
- Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Patrick Scheffler
- Department of Otolaryngology - Head and Neck Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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5
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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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König TT, Frankenbach ML, Gianicolo E, Holler AS, von Sochaczewski CO, Wessel L, Widenmann A, Klos L, Kolb S, Siaplaouras J, Niessner C. Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age. Eur J Pediatr 2023:10.1007/s00431-023-04923-3. [PMID: 36976316 PMCID: PMC10257632 DOI: 10.1007/s00431-023-04923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4-17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370-554) compared to controls (626; 95% CI: 576-676), although there was no statistically significant difference in the sports index (187; 95% CI: 156-220 versus 220; 95% CI: 203-237). A lower mean weight-for-age and height-for-age, additional urogenital (r = - 0.20, p = 0.04) or anorectal malformation (r = - 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found. Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021. WHAT IS KNOWN • Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity. WHAT IS NEW • Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers. • Physical activity was associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.
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Affiliation(s)
- Tatjana Tamara König
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Maria-Luisa Frankenbach
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Anne-Sophie Holler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Christina Oetzmann von Sochaczewski
- Sektion Kinderchirurgie, Klinik und Poliklinik Für Allgemein-, Viszeral-, Thorax- Und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Lucas Wessel
- Pediatric Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Anke Widenmann
- Patient Organisation for Esophageal Diseases KEKS e.V., Stuttgart, Germany
| | - Leon Klos
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Simon Kolb
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Claudia Niessner
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
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7
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Dellenmark-Blom M, Örnö Ax S, Öst E, Svensson JF, Kassa AM, Jönsson L, Abrahamsson K, Gatzinsky V, Stenström P, Tollne A, Omling E, Engstrand Lilja H. Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study. Orphanet J Rare Dis 2022; 17:239. [PMID: 35725462 PMCID: PMC9207832 DOI: 10.1186/s13023-022-02381-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In 10-15% of children with esophageal atresia (EA) delayed reconstruction of esophageal atresia (DREA) is necessary due to long-gap EA and/or prematurity/low birth weight. They represent a patient subgroup with high risk of complications. We aimed to evaluate postoperative morbidity and health-related quality of life (HRQOL) in a Swedish national cohort of children with DREA. METHODS Postoperative morbidity, age-specific generic HRQOL (PedsQL™ 4.0) and condition-specific HRQOL (The EA-QOL questionnaires) in children with DREA were compared with children with EA who had primary anastomosis (PA). Factors associated with the DREA group's HRQOL scores were analyzed using Mann-Whitney U-test and Spearman's rho. Clinical data was extracted from the medical records. Significance level was p < 0.05. RESULTS Thirty-four out of 45 families of children with DREA were included and 30 returned the questionnaires(n = 8 children aged 2-7 years; n = 22 children aged 8-18 years). Compared to children with PA(42 children aged 2-7 years; 64 children aged 8-18 years), there were no significant differences in most early postoperative complications. At follow-up, symptom prevalence in children aged 2-7 with DREA ranged from 37.5% (heartburn) to 75% (cough). Further digestive and respiratory symptoms were present in ≥ 50%. In children aged 8-18, it ranged from 14.3% (vomiting) to 40.9% (cough), with other digestive and airway symptoms present in 19.0-27.3%. Except for chest tightness (2-7 years), there were no significant differences in symptom prevalence between children with DREA and PA, nor between their generic or condition-specific HRQOL scores (p > 0.05). More children with DREA underwent esophageal dilatations (both age groups), gastrostomy feeding (2-7 years), and antireflux treatment (8-18 years), p < 0.05. Days to hospital discharge after EA repair and a number of associated anomalies showed a strong negative correlation with HRQOL scores (2-7 years). Presence of cough, airway infection, swallowing difficulties and heartburn were associated with lower HRQOL scores (8-18 years), p < 0.05. CONCLUSIONS Although children with DREA need more treatments, they are not a risk group for postoperative morbidity and impaired HRQOL compared with children with PA. However, those with a long initial hospital stay, several associated anomalies and digestive or respiratory symptoms risk worse HRQOL. This is important information for clinical practice, families and patient stakeholders.
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Affiliation(s)
- Michaela Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.
| | - Sofie Örnö Ax
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jan F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Linus Jönsson
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kate Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vladimir Gatzinsky
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - AnnaMaria Tollne
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Omling
- Department of Pediatric Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
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8
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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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9
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Evanovich DM, Wang JT, Zendejas B, Jennings RW, Bajic D. From the Ground Up: Esophageal Atresia Types, Disease Severity Stratification and Survival Rates at a Single Institution. Front Surg 2022; 9:799052. [PMID: 35356503 PMCID: PMC8959439 DOI: 10.3389/fsurg.2022.799052] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Esophageal atresia (EA), although a rare congenital anomaly, represents one of the most common gastrointestinal birth defects. There is a gap in our knowledge regarding the impact of perioperative critical care in infants born with EA. This study addresses EA types, disease severity stratification, and mortality in a retrospective cohort at a single institution. Institutional Review Board approved our retrospective cross-sectional study of term-born (n = 53) and premature infants (28–37 weeks of gestation; n = 31) that underwent primary surgical repair of EA at a single institution from 2009–2020. Demographic and clinical data were obtained from the electronic medical record, Powerchart (Cerner, London, UK). Patients were categorized by (i) sex, (ii) gestational age at birth, (iii) types of EA (in relation to respiratory tract anomalies), (iv) co-occurring congenital anomalies, (v) severity of disease (viz. American Society of Anesthesiologists (ASA) and Pediatric Risk Assessment (PRAm) scores), (vi) type of surgical repair for EA (primary anastomosis vs. Foker process), and (vii) survival rate classification using Spitz and Waterston scores. Data were presented as numerical sums and percentages. The frequency of anatomical types of EA in our cohort parallels that of the literature: 9.5% (8/84) type A, 9.5% (8/84) type B, 80% (67/84) type C, and 1% (1/84) type D. Long-gap EA accounts for 88% (7/8) type A, 75% (6/8) type B, and 13% (9/67) type C in the cohort studied. Our novel results show a nearly equal distribution of sex per each EA type, and gestational age (term-born vs. premature) by anatomical EA type. PRAm scoring showed a wider range of disease severity (3–9) than ASA scores (III and IV). The survival rate in our EA cohort dramatically increased in comparison to the literature in previous decades. This retrospective analysis at a single institution shows incidence of EA per sex and gestational status for anatomical types (EA type A-D) and by surgical approach (primary anastomosis vs. Foker process for short-gap vs. long-gap EA, respectively). Despite its wider range, PRAm score was not more useful in predicting disease severity in comparison to ASA score. Increased survival rates over the last decade suggest a potential need to assess unique operative and perioperative risks in this unique population of patients. Presented findings also represent a foundation for future clinical studies of outcomes in infants born with EA.
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Affiliation(s)
- Devon Michael Evanovich
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Tufts School of Medicine, Tufts University, Boston, MA, United States
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Benjamin Zendejas
- Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, MA, United States
| | - Russell William Jennings
- Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
- *Correspondence: Dusica Bajic
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10
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König TT, Gianicolo E, Frankenbach L, Wittenmeier E, Muensterer OJ. Esophageal Interventions in Infants Born with Esophageal Atresia: A Comprehensive Analysis of a National Database. Eur J Pediatr Surg 2022; 32:42-49. [PMID: 34891191 DOI: 10.1055/s-0041-1739415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Esophageal atresia (EA) is a rare malformation that often requires a series of procedures, including surgical primary anastomosis, staged repair, and endoscopic procedures. Actual numbers and trends in interventions and variety in treatment strategies remain unclear. MATERIALS AND METHODS Data from the German federal bureau of statistics containing all EA-related inpatient procedures encoded from 2005 until 2018 were analyzed for children during the first year of life. The sum of esophageal anastomoses and replacements was used to calculate an estimate of incidence of EA. RESULTS Over 14 years, 12,627,888 inpatient cases were recorded in infants in Germany. The mean incidence of EA was 1 per 4,217 live births. On average, 163.3 (95% confidence interval [CI]: 150.8-176.1) esophageal anastomoses, 11.2 (95% CI: 8.7-13.7) esophageal lengthening procedures, and 6.7 (95% CI: 5.42-8.00) esophageal replacements were recorded annually. Overall, 187.8 (95% CI: 147.1-200.4) endoluminal treatments (ballon dilatation, bougienage, stent placement, or injection) were performed per 100 anastomoses. Over the years, bougienage was increasingly replaced by ballon dilatation as primary treatment. Boys had a significantly higher number of esophageal procedures than girls, but the incidence of endoscopic treatments in relation to anastomoses was the same for both genders. CONCLUSION The low incidence of EA in relation to a relatively large number of units treating those patients in Germany may pose challenges for maintaining competency and training of all specialists involved. The number of esophagoscopic treatments for esophageal stricture per anastomosis is lower than previously estimated.
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Affiliation(s)
- Tatjana T König
- Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Rheinland-Pfalz, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatisics, Epidemiology and Informatics (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Rheinland-Pfalz, Germany
| | - Luisa Frankenbach
- Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Rheinland-Pfalz, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Rheinland-Pfalz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Rheinland-Pfalz, Germany
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11
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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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12
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Schmedding A, Wittekindt B, Schloesser R, Hutter M, Rolle U. Outcome of esophageal atresia in Germany. Dis Esophagus 2021; 34:5912927. [PMID: 32995846 DOI: 10.1093/dote/doaa093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the outcome of esophageal atresia in Germany in a retrospective observational study of a large cohort. Data from the major health insurance company in Germany, which covers approximately 30% of German patients, were analyzed. All patients born and registered between 2009 and 2013 with a diagnosis of esophageal atresia at first admission to the hospital were included. Mortality was analyzed during the first year of life. We identified 287 patients with esophageal atresia, including 253 with and 34 without tracheoesophageal fistula. Associated anomalies were found in 53.7% of the patients; the most frequent were cardiac anomalies (41.8%), anomalies of the urinary tract (17.4%), and atresia of the colon, rectum, and anus (9.4%). Forty-one patients (14.3%) had a birth weight <1500 g. Seventeen patients (5.9%) died before surgery. Gastrostomy was performed during the index admission in 70 patients (25.9%). The reconstruction of the esophageal passage was performed in 247 patients (93.9%). Forty-eight percent of the patients who underwent an operation required dilatation. The mortality rate in the patients who underwent an operation was 10.4%. These results from Germany correspond to the international results that have been reported. The number of dilatations was in the middle of the range of those reported in the literature; the overall mortality rate was in the upper portion of the range of the international rates. Efforts should be made to establish a clinical registry to measure and improve the quality of care for this and other rare conditions.
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Affiliation(s)
- A Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - B Wittekindt
- Department of Neonatology, University Hospital, Goethe University Frankfurt,Frankfurt am Main, Germany
| | - R Schloesser
- Department of Neonatology, University Hospital, Goethe University Frankfurt,Frankfurt am Main, Germany
| | - M Hutter
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - U Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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Koumbourlis AC, Belessis Y, Cataletto M, Cutrera R, DeBoer E, Kazachkov M, Laberge S, Popler J, Porcaro F, Kovesi T. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55:2713-2729. [PMID: 32716120 DOI: 10.1002/ppul.24982] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Mary Cataletto
- Division of Pediatric Pulmonary Medicine, New York University, Winthrop University Hospital, Mineola, New York
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Emily DeBoer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver, Children's Hospital Colorado Breathing Institute, Aurora, Colorado
| | - Mikhail Kazachkov
- Department of Pediatric Pulmonology, Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, New York
| | - Sophie Laberge
- Department of Pediatrics, Division of Respiratory Medicine, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Jonathan Popler
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Federica Porcaro
- Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Thomas Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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