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Le-Nguyen A, Landry ÉK, Jantchou P, Daoust C, Piché N, Aspirot A, Faure C. Outcomes of Premature Infants With Type C Esophageal Atresia. J Pediatr Surg 2024; 59:869-873. [PMID: 38402129 DOI: 10.1016/j.jpedsurg.2024.01.036] [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: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND To review the outcomes of premature patients with type C esophageal atresia (EA). METHODS In this retrospective cohort study, charts of patients of type C EA patients were reviewed from 1992 to 2022. Outcomes of premature patients were compared to term patients. Preterm patients were analyzed to compare outcomes of infants with very low birth weights (VLBW) to patients >1,500 g as well as primary versus delayed anastomosis. RESULTS Among 192 type C EA, 67 were premature. Median and interquartile range (IQR) gestational age and birth weight of preterm patients were 34 [33-36] weeks and 1965 [1740-2290] g. Delayed anastomosis was performed in 12 (18%) preterm vs. 3 (2%) term patients (p = 0.0003). Short-term postoperative outcomes were similar between preterm and term patients, except for recurrent fistula (16% vs. 6%, p = 0.01). Prematurity was associated with an increased need for long-term enteral tube feeding (56% vs. 10%, p = 0.0001) and parenteral nutrition (10 days vs. 0 days, p = 0.0004). The length of stay was 3 times longer when patients were premature (50 days vs. 17 days, p = 0.002). Delayed surgery in preterm patients was associated with post-operative leaks, strictures, recurrent fistula, prolonged enteral tube feeding, and gastrostomy insertion. Patients with very low birth weight (VLBW) were compared to other preterm patients and showed no difference in terms of rate of delayed surgery, and post-operative outcomes. CONCLUSION Despite increased prematurity-related comorbidities and low birth weight, premature infants with type C EA/TEF have similar post-operative outcomes to term patients though recurrent fistula was more frequent with prematurity. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Annie Le-Nguyen
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
| | - Émilie Kate Landry
- Department of General Surgery, Université de Montréal, Montréal, QC, Canada
| | - Prévost Jantchou
- Department of Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Caroline Daoust
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Ann Aspirot
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Christophe Faure
- Department of Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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Shimizu T, Takamizawa S, Yanai T, Tsugawa J, Torikai M, Uemura K, Ohba G, Takeuchi Y, Yokoyama S, Ueda S. Optimal Surgical Method and Timing for Low-birth-weight Esophageal Atresia Babies: Multi-institutional Observational Study. J Pediatr Surg 2024; 59:182-186. [PMID: 37957100 DOI: 10.1016/j.jpedsurg.2023.10.013] [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: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
AIM OF THE STUDY Previous research has shown that low birth weight is one of the risk factors for esophageal atresia. However, there remains a paucity of evidence on the timing and the treatment method. METHOD Data were collected using a multi-institutional observational study in 11 hospitals that performed surgeries on esophageal atresia babies whose birth weights were ≤1500 g from 2001 to 2020. RESULTS Of the 46 patients analyzed, median birth weight was 1233 (IQR 1042-1412) g. Within 46 cases, 19 (41%) underwent definitive esophageal anastomosis at the median of age in 8 (IQR 2-101) days. Thirteen out of 19 experienced either closure of tracheoesophageal fistula, gastrostomy, or esophageal banding at the first operation, followed by esophageal anastomosis. Seven infants, including four cases of <1000 g, underwent anastomosis after one month of age to wait for weight gain (variously 2-3000 g). Twenty-one out of 27 infants (78%) who did not receive anastomosis died within one year of age, including 21 (78 %) with major cardiac anomalies and 24 (89%) with severe chromosomal anomalies (trisomy 18). Six survivors in this group, all with trisomy 18, lived with palliative surgical treatments. CONCLUSION In our study, the definitive esophageal anastomosis was effective either at the first operation or as a later treatment after gaining weight. Although having severe anomalies, some infants receive palliative surgical treatments, and the next surgery was considered depending on their condition. EVIDENCE LEVEL II.
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Affiliation(s)
- Toru Shimizu
- University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 9030215, Japan; Nagano Children's Hospital, Japan.
| | | | | | | | | | | | | | | | | | - Shinichiro Ueda
- University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 9030215, Japan
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Krishnan U, Dumont MW, Slater H, Gold BD, Seguy D, Bouin M, Wijnen R, Dall'Oglio L, Costantini M, Koumbourlis AC, Kovesi TA, Rutter MJ, Soma M, Menzies J, Van Malleghem A, Rommel N, Dellenmark-Blom M, Wallace V, Culnane E, Slater G, Gottrand F, Faure C. The International Network on Oesophageal Atresia (INoEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula. Nat Rev Gastroenterol Hepatol 2023; 20:735-755. [PMID: 37286639 DOI: 10.1038/s41575-023-00789-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Oesophageal atresia-tracheoesophageal fistula (EA-TEF) is a common congenital digestive disease. Patients with EA-TEF face gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life issues in childhood, adolescence and adulthood. Although consensus guidelines exist for the management of gastrointestinal, nutritional, surgical and respiratory problems in childhood, a systematic approach to the care of these patients in adolescence, during transition to adulthood and in adulthood is currently lacking. The Transition Working Group of the International Network on Oesophageal Atresia (INoEA) was charged with the task of developing uniform evidence-based guidelines for the management of complications through the transition from adolescence into adulthood. Forty-two questions addressing the diagnosis, treatment and prognosis of gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life complications that patients with EA-TEF face during adolescence and after the transition to adulthood were formulated. A systematic literature search was performed based on which recommendations were made. All recommendations were discussed and finalized during consensus meetings, and the group members voted on each recommendation. Expert opinion was used when no randomized controlled trials were available to support the recommendation. The list of the 42 statements, all based on expert opinion, was voted on and agreed upon.
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Affiliation(s)
- Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Michael W Dumont
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hayley Slater
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin D Gold
- Children's Center for Digestive Health Care, GI Care for Kids, LLC, Atlanta, GA, USA
| | - David Seguy
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Department of Nutrition, CHU Lille, Lille, France
| | - Mikael Bouin
- University of Montreal, CHUM Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Rene Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Thomas A Kovesi
- Deptartment of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Rutter
- Division of Paediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Marlene Soma
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Otolaryngology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Nathalie Rommel
- Department of Gastroenterology, Department of Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, ExpORL, Deglutology, University of Leuven, Leuven, Belgium
| | - Michaela Dellenmark-Blom
- Department of Paediatric Surgery, The Queen Silvia Children's hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Wallace
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Graham Slater
- EAT Oesophageal Atresia Global Support Groups e.V., Stuttgart, Germany
| | - Frederic Gottrand
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
- Institute for Translational Research in Inflammation INFINITE, Inserm Faculté de Médecine, Université de Lille, Lille, France
| | - Christophe Faure
- Division of Paediatric Gastroenterology & Oesophagus Development and Engineering Lab, Sainte-Justine Hospital, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
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Wyllie T, Folaranmi E, Sekaran P, Watkins WJ, Chakraborty M. Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery: A Systematic Review and Meta-analysis. J Pediatr Surg 2023; 58:1954-1962. [PMID: 37355433 DOI: 10.1016/j.jpedsurg.2023.05.024] [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: 11/18/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Anastomotic stricture is a common postoperative complication of oesophageal atresia ± tracheoesophageal fistula (OA/TOF) repair. Acid gastro-oesophageal reflux disease (GORD) is considered to be a factor in stricture formation and acid suppression medication is recommended post-operatively in consensus guidance. We aimed to investigate whether patients who were treated prophylactically with acid suppression medication had a reduced incidence of strictures compared to those who did not receive it. METHODS A systematic review of studies was performed, searching multiple databases without language or date restrictions. Multiple reviewers independently assessed study eligibility and literature quality. The primary outcome was anastomotic stricture formation, with secondary outcomes of GORD, anastomotic leak, and oesophagitis. Meta-analysis was performed using a random effects model, and the results were expressed as an odds ratio (OR) with 95% confidence intervals (CI). RESULTS No randomised studies on the topic were identified. Twelve observational studies were included in the analysis with ten reporting the primary outcome. The quality assessment showed a high risk of bias in several papers, predominantly due to non-objective methods of assessment of oesophageal stricture and the non-prospective, non-randomised nature of the studies. Overall, 1395 patients were evaluated, of which 753 received acid suppression medication. Meta-analysis revealed a trend towards increased odds of anastomotic strictures in infants receiving prophylactic medication, but this was not statistically significant (OR 1.33; 95% CI 0.92, 1.92). No significant differences were found in secondary outcomes. CONCLUSIONS This meta-analysis found no evidence of a statistically significant link between the prophylactic prescribing of acid suppression medication and the risk of developing anastomotic stricture after OA repair. The literature in this area is limited to observational studies and a randomised controlled trial is recommended to explore this question. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas Wyllie
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Eniola Folaranmi
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - Prabhu Sekaran
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - W John Watkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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Peri- and neonatal factors influencing mortality and morbidity 2 years after esophageal atresia primary repair: a single center retrospective study. Eur J Pediatr 2023; 182:889-897. [PMID: 36515705 DOI: 10.1007/s00431-022-04740-0] [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: 10/11/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED Long-term digestive, respiratory, and neurological morbidity is significant in children who have undergone surgery for esophageal atresia (EA), especially after staged repair for long-gap EA. Risk factors for morbidity after primary repair (non-long-gap populations) have been less documented. We investigated peri- and neonatal factors associated with unfavorable outcomes in children 2 years after primary esophageal anastomosis. This was a single-center retrospective study, based on neonatal, surgical, and pediatric records of children born between December 1, 2002, and December 31, 2018, and followed up to age 2 years. The primary endpoint was unfavorable outcome at 2 years of age, defined by death or survival with severe respiratory, digestive, or neurologic morbidity. Univariate analyses followed by logistic regression analyses were performed to identify the peri- and neonatal risk factors of unfavorable outcomes among survivors at discharge. A total of 150 neonates were included (mean birth weight 2520 ± 718 g, associated malformations 61%); at age 2, 45 (30%) had one or more severe morbidities and 11 had died during the neonatal stay and 2 after discharge (8.7% deaths). In multivariate analyses of the 139 survivors at discharge, duration of ventilatory support (invasive and non-invasive) for more than 8 days (OR 3.74; CI95% [1.68-8.60]; p = 0.001) and achievement of full oral feeding before hospital discharge (OR 0.20; CI95% [0.06-0.56]; p = 0.003) were independently associated with adverse outcome after adjustment for sex, preterm birth, associated heart defect, any surgical complication, and the occurrence of more than one nosocomial infections during the neonatal stay. CONCLUSIONS Post-operative ventilation and feeding management strategies may represent an opportunity for quality-of-care improvement to positively impact long-term outcomes after primary esophageal atresia repair. WHAT IS KNOWN • Children operated on for esophageal atresia experience long-term digestive, respiratory, and neurologic morbidity, especially after multiple-stage esophageal repair. • Exclusive oral feeding at discharge is associated with a decreased risk of medical complications in the first years of life, in studies including all types of esophageal atresia repair. Outcomes of children after primary repair (non-long gap populations) have been less documented. WHAT IS NEW • In our retrospective cohort of children with one-stage esophageal atresia repair, ventilatory support for more than 8 days and inability to achieve full oral feeding before hospital discharge in the neonatal period were independently associated with adverse digestive, respiratory, and neurologic outcomes at 2 years in survivors. • Both these factors are potentially modifiable, representing an opportunity for quality-of-care improvement to positively impact long-term outcomes. These results might also help identify children at risk of unfavorable evolution, to customize a multi-disciplinary follow-up program.
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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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Walk RM. Esophageal Atresia and Tracheoesophageal Fistula. Surg Clin North Am 2022; 102:759-778. [DOI: 10.1016/j.suc.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schlee D, Theilen TM, Fiegel H, Hutter M, Rolle U. Outcome of esophageal atresia: inborn versus outborn patients. Dis Esophagus 2022; 35:6500727. [PMID: 35016219 DOI: 10.1093/dote/doab092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/22/2021] [Indexed: 12/22/2022]
Abstract
Esophageal atresia (EA) is a rare congenital disease which is usually not of the detected prenatally. Due to the lack of prenatal diagnosis, some newborns with EA are born outside of specialized centers. Nevertheless, centralized care of EA has been proposed, even if a clear volume-outcome association in EA management remains unconfirmed. Furthermore, whether outcomes differ between outborn and inborn patients with EA has not been systematically investigated. Therefore, this single-center, retrospective study aimed to investigate EA management and outcomes with a special focus on inborn versus outborn patients. The following data were extracted from the medical records of infants with EA from 2009 to 2019: EA type, associated anomalies, complications, and long-term outcome. Patients were allocated into inborn and outborn groups. Altogether, 57 patients were included. Five patients were excluded (referral before surgery, loss of data, death before surgery [n = 1], and incorrect diagnosis [diverticulum, n = 1]). Among all patients, the overall survival rate was 96%, with no mortalities among outborn patients. The overall hospitalization period was shorter for outborn patients. The median follow-up durations were 3.8 years and 3.2 years for inborn and outborn patients, respectively. Overall, 15% of patients underwent delayed primary anastomosis (long-gap atresia [n = 4] and other reasons [n = 4]). Early complications included three anastomotic leakages and one post-operative fistula; 28% of patients developed strictures, which required dilatation, and 38% of patients showed relevant gastroesophageal reflux, which required fundoplication, without any differences between the groups. The two groups had comparable low mortality and expected high morbidity with no significant differences in outcome. The outborn group showed nonsignificant trends toward lower morbidity and shorter hospitalization periods, which might be explained by the overall better clinical status.
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Affiliation(s)
- Denise Schlee
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M., Goethe-University Frankfurt/Main, Germany
| | - Till-Martin Theilen
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M., Goethe-University Frankfurt/Main, Germany
| | - Henning Fiegel
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M., Goethe-University Frankfurt/Main, Germany
| | - Martin Hutter
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M., Goethe-University Frankfurt/Main, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M., Goethe-University Frankfurt/Main, Germany
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Hong SM, Chen Q, Cao H, Hong JJ, Huang JX. Developing a new predictive index for anastomotic leak following the anastomosis of esophageal atresia: preliminary results from a single centre. J Cardiothorac Surg 2022; 17:131. [PMID: 35643516 PMCID: PMC9148473 DOI: 10.1186/s13019-022-01878-8] [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: 07/14/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to determine a predictive index for the risk of anastomotic leak following esophageal atresia anastomosis, Methods This article reviewed the clinical data of 74 children with esophageal atresia in Fujian Children's hospital. The risk factors for anastomotic leak were analysed, and a new predictive index was proposed. Results The incidence of anastomotic leak was 29.7% after anastomosis in 74 children with esophageal atresia. Birth weight and gap length were risk factors for anastomotic leak. Logistic regression analysis showed that birth weight (Wald 2 = 4.528, P = 0.033, OR = 0.273) was a protective factor for anastomotic leak, whereas gap length (Wald 2 = 7.057, P = 0.008, OR = 2.388) was a risk factor for anastomotic leak. The ratio of gap length to birth weight had a positive predictive effect on the occurrence of anastomotic leak (AUC = 0.732, P = 0.002). Conclusion Birth weight and gap length are important predictors of anastomotic leak in esophageal atresia. Measurement of the ratio of gap length to birth weight is a helpful predictive index for anastomotic leak following the anastomosis of esophageal atresia.
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Affiliation(s)
- Song-Ming Hong
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, China.,Fujian Children's Hospital, 966 Hengyu Road, Fuzhou City, Fujian Province, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou City, China
| | - Qiang Chen
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, China.,Fujian Children's Hospital, 966 Hengyu Road, Fuzhou City, Fujian Province, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou City, China
| | - Hua Cao
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, China.,Fujian Children's Hospital, 966 Hengyu Road, Fuzhou City, Fujian Province, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou City, China
| | - Jun-Jie Hong
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, China.,Fujian Children's Hospital, 966 Hengyu Road, Fuzhou City, Fujian Province, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou City, China
| | - Jin-Xi Huang
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, China. .,Fujian Children's Hospital, 966 Hengyu Road, Fuzhou City, Fujian Province, China. .,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, China. .,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou City, China.
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10
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Koivusalo AI, Suominen JS, Pakarinen MP. Oesophageal atresia with very low birth weight: Clinical characteristics and long-term outcome. J Pediatr Surg 2022; 57:192-194. [PMID: 34865828 DOI: 10.1016/j.jpedsurg.2021.10.047] [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: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY An assessment of the clinical data and outcome of patients with oesophageal atresia (OA) with very low birth weight (VLBW) was completed. METHOD With ethical consent, we reviewed the records of 327 successive patients with OA from 1980 to 2020. Main outcome measures survival and oesophageal repair were compared between patients with VLBW(≤1500 g) and with BW>1500 g. RESULTS Thirty-four (10%) patients had VLBW. Gross types of OA in VLBW were similar as in other patients: A (15%/7%), B (3%/3%), C (78%/82%), D (3%/4%), E (0%/7%), F (0%/1%) (p = 0.16-0.99). In VLBW the incidence of congenital heart disease (CHD) (47%) and trisomy 13/18 and Cri du Chat (15%) were higher than in BW>1500 g (23% and 1%), (p = 0.001 both). In VLBW one-month mortality was 35% vs 4% in patients with BW>1500 g (p < 0.001), overall mortality 56% and 8% (p < 0.001), respectively. Cause of one-month mortality in VLBW (12 patients) were CHD w/wo chromosomal abnormality (n = 7), cerebral hemorrhage (n = 2), gastric perforation (n = 1), anastomotic leakage (n = 1) and pulmonary hemorrhage (n = 1). Of VLBW patients 79% and of other patients 99% underwent oesophageal repair (p < 0.001). Repair in VLBW patients included early (n = 18) or delayed (n = 5) end-to-end anastomosis and reconstruction (n = 4). Anastomotic complications occurred in 24% of patients with VLBW and in 17% with BW>1500 g, (p = 0.31). From 1980-2000 to 2001-2020 survival in VLBW changed from 11% to 81% (p = 0.002). During 2001 - 2020 all VLBW patients underwent repair. CONCLUSION OA with VLBW had high incidence of life-threatening associated anomalies and decreased survival. Recently survival and rate of oesophageal repair have improved significantly.
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Affiliation(s)
- Antti I Koivusalo
- New Children´s Hospital, Section of Paediatric Surgery, University of Helsinki, Stenbackinkatu 9 00290 PO Box 281, Helsinki, Finland.
| | - Janne S Suominen
- New Children´s Hospital, Section of Paediatric Surgery, University of Helsinki, Stenbackinkatu 9 00290 PO Box 281, Helsinki, Finland
| | - Mikko P Pakarinen
- New Children´s Hospital, Section of Paediatric Surgery, University of Helsinki, Stenbackinkatu 9 00290 PO Box 281, Helsinki, Finland
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Patterson K, Beyene TJ, Asti L, Althubaiti A, Lind M, Pattisapu P. Quantifying Upper Aerodigestive Sequelae in Esophageal Atresia/Tracheoesophageal Fistula Neonates. Laryngoscope 2021; 132:695-700. [PMID: 34369591 DOI: 10.1002/lary.29798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/08/2021] [Accepted: 07/24/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined rates of upper aerodigestive tract (UADT) procedures in a multi-institutional cohort of neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF) to estimate secondary UADT pathology. METHODS A retrospective cohort study was performed using a previously-validated population of patients with EA/TEF within the Pediatric Health Information System (PHIS) between 2007 and 2015. ICD-9/10-CM codes for aerodigestive procedures were examined from 2007 to 2020: 1) diagnostic direct laryngoscopy and/or bronchoscopy (DLB), 2) DLB with intervention, 3) tracheostomy, 4) gastrostomy, 5) fundoplication, 6) aortopexy, 7) laryngotracheoplasty, and 8) esophageal dilation. Associations between procedures and demographics, length of gestation, and weight were estimated using generalized linear mixed models. RESULTS We identified 2,509 patients with EA/TEF from 47 hospitals, 56.7% male and 43.3% female. Median length of stay for the first admission was 24 days (interquartile range: 12-55). Of these patients, 1,943 (77.4%) had at least one aerodigestive procedure within 14 admissions. Specifically, 1,635 (65.2%) underwent diagnostic DLB, 85 (3.4%) DLB with intervention, 167 (6.7%) tracheostomy, 1,043 (41.2%) gastrostomy, 211 (11.0%) fundoplication, 52 (2.1%) aortopexy, 161 (6.4%) laryngotracheoplasty, and 207 (8.3%) esophageal dilation. Preterm gestation increased odds of tracheostomy (adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7), gastrostomy (OR 2.1, CI 1.7-2.7), fundoplication (OR 1.7, CI 1.1-2.4), aortopexy (OR 5.8, CI 2.1-16.1), and esophageal dilation (OR 2.0, CI 1.4-3.0). Very low birth weight (<1,500 g) increased odds of gastrostomy (OR 2.5, CI 1.6-3.8). CONCLUSION Patients with EA/TEF frequently have aerodigestive sequelae. This work helps quantify aerodigestive needs in neonates with EA/TEF, suggesting early otolaryngology evaluation in their care. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Kelli Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Abdulrahman Althubaiti
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, U.S.A
| | - Meredith Lind
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, U.S.A
| | - Prasanth Pattisapu
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, U.S.A
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Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study. CHILDREN-BASEL 2021; 8:children8010055. [PMID: 33477368 PMCID: PMC7830350 DOI: 10.3390/children8010055] [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: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. METHODS Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. RESULTS The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score -2.68 ± 0.8 vs -0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents' perceptions of the general health and emotional state of their babies (p < 0.001). CONCLUSIONS The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.
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