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Dimitrov G, Aumar M, Duhamel A, Wanneveich M, Gottrand F. Proton pump inhibitors in esophageal atresia: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:457-470. [PMID: 38262739 DOI: 10.1002/jpn3.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs). However, there are still controversies on the prophylactic use of PPIs and the efficacy of PPIs on GERD and EA complications in this special condition. The aim of the study is to assess the prophylactic use of PPIs in pediatric patients with EA and its complications. We, therefore, performed a systematic review including all reports on the subject from 1980 to 2022. We conducted meta-analysis of the pooled proportion of PPI-and no PPI groups using random effect model, meta-regression, and estimate heterogeneity by heterogeneity index I2 . Thirty-eight reports on the topic met the criteria selection, representing a cumulative 6044 patients with EA. Prophylactic PPI prescription during the first year of life does not appear to prevent GERD persistence at follow-up and is not associated with a significantly reduced rate of antireflux surgical procedures (ARP). PPIs improve peptic esophagitis and induce remission of eosinophilic esophagitis at a rate of 50%. Their effect on other GERD outcomes is uncertain. Evidence suggests that PPIs do not prevent anastomotic stricture, Barrett's esophagus, or respiratory complications. PPI use in EA can improve peptic and eosinophilic esophagitis but is ineffective on the other EA complications. Side effects of PPIs in EA are almost unknown.
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Affiliation(s)
- Georges Dimitrov
- Unit of Pediatric Surgery, Unit of Pediatrics, Competence Centre for Rare Esophageal Diseases, University Hospital Center of Orléans, Orléans, France
| | - Madeleine Aumar
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- Biostatistics Unit, University Hospital of Lille, Lille, France
| | | | - Frédéric Gottrand
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
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2
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Moradi B, Banihashemian M, Radmard AR, Tahmasebpour AR, Gity M, Zarkesh MR, Piri S, Zeinoddini A. A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 1 Esophagus to Colon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2601-2613. [PMID: 34962317 DOI: 10.1002/jum.15932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/03/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Banihashemian
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoumeh Gity
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zarkesh
- Department of Neonatology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Solmaz Piri
- Department of International Affairs, National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran
| | - Atefeh Zeinoddini
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
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3
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Thompson K, Zendejas B, Kamran A, Svetanoff WJ, Meisner J, Zurakowski D, Staffa SJ, Ngo P, Manfredi M, Yasuda JL, Jennings RW, Smithers CJ, Hamilton TE. Predictors of anti-reflux procedure failure in complex esophageal atresia patients. J Pediatr Surg 2022; 57:1321-1330. [PMID: 34509283 DOI: 10.1016/j.jpedsurg.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anti-reflux procedures (ARP) in esophageal atresia (EA) patients can be challenging and prone to failure. These challenges become more evident with increasing complexity of EA. We sought to determine predictors of ARP failure in complex EA patients. METHODS Single-institution retrospective review of complex EA patients (e.g. long-gap EA, esophageal strictures, hiatal hernia, and reoperative ARP) who underwent an ARP from 2002 to 2019. ARP failure was defined as hiatal hernia recurrence, wrap migration/loosening, or need for reoperation. Predictors of failure were evaluated using univariate and multivariable time-to-event analysis. RESULTS 121 patients underwent 140 ARP at a median age of 13.5 months (IQR 7, 26.5). Nissen fundoplication (89%) was the most common ARP. Mesh (bovine pericardium) reinforcement was used in 41% of the patients. Median follow-up was 3.2 years (IQR 0.9, 5.8); 44 instances of ARP failure occurred (31%), though only 20 (14%) required reoperation. Median time to failure was 8.7 months (IQR 3.2, 25). Though fewer mesh-reinforced ARP failed (21% with vs 39% without, p = 0.02), on multivariable analysis only partial fundoplication (aHR 2.22 [95% CI 1.01-4.78]) and minimally invasive repair (aHR 2.57 [95% CI 1.12-6.01]) were significant predictors of ARP failure. CONCLUSION In our practice of complex EA patients, where ARP fail in nearly one third of cases, a Nissen fundoplication performed via laparotomy provided the lowest risk of ARP failure.
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Key Words
- ARP, Anti-reflux procedure
- ARPF, Anti-reflux procedure failure
- Abbreviations: EA, Esophageal atresia
- Anti-reflux procedure
- EGD, esophagogastric duodenoscopy
- Esophageal atresia
- GEJ, gastroesophageal junction
- HH, hiatal hernia
- Hiatal hernia
- LGEA, Long gap esophageal atresia
- MFOIS, Modified functional oral intake scale
- MIS, minimally invasive surgery
- Nissen fundoplication
- SSI, surgical sight infection
- UGI, upper gastrointestinal series
- gerd, Gastroesophageal reflux disease
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Affiliation(s)
- Kyle Thompson
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Benjamin Zendejas
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Ali Kamran
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO USA
| | - Jay Meisner
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA USA
| | - Peter Ngo
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Michael Manfredi
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Jessica L Yasuda
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Russell W Jennings
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - C Jason Smithers
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL USA.
| | - Thomas E Hamilton
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA.
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Kassif E, Elkan Miller T, Tsur A, Trozky Y, Gur T, De Castro H, Hadi E, Yulzari V, Weissmann-Brenner A, Messing B, Yoeli-Ullman R, Sharon R, Mazaki-Tovi S, Achiron R, Weisz B, Weissbach T. Dynamic esophageal patency assessment: an effective method for prenatally diagnosing esophageal atresia. Am J Obstet Gynecol 2021; 225:674.e1-674.e12. [PMID: 34146530 DOI: 10.1016/j.ajog.2021.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Esophageal atresia is a major anomaly with a low prenatal detection rate. We propose a sonographic method termed dynamic esophageal patency assessment. OBJECTIVE This study aimed to assess the feasibility and performance of the dynamic esophageal patency assessment in a high-risk population. STUDY DESIGN A prospective study was conducted in a single tertiary fetal ultrasound unit for 12 months. The study group included pregnant women referred for a targeted scan because of one or more of the following: (1) polyhydramnios; (2) small or absent stomach; (3) vertebral, anal atresia, cardiac, tracheoesophageal fistula, renal, and limb abnormalities; (4) first-degree relative with esophageal atresia; and (5) genetic mutation associated with esophageal atresia. In addition to dynamic esophageal patency assessment, a comprehensive anomaly scan was carried out. The fetal esophagus was observed during swallowing. Cases that demonstrated uninterrupted fluid propagation through the esophagus were classified as normal. Cases that demonstrated interrupted fluid propagation, with the formation of a pouch, were classified as abnormal. Cases with unclear visualization of the esophagus or cases that failed to demonstrate either fluid propagation or a pouch were classified as undetermined. Dynamic esophageal patency assessment results were compared with postnatal findings, considered "gold standard." Test performance indices and intra- and interobserver agreements were calculated. RESULTS For 12 months, 130 patients were recruited, and 132 fetuses were scanned. The median gestational age (interquartile range) at the time of scan was 31.4 weeks (29.0-35.3). Of 132 fetuses enrolled, 123 (93.2%) were normal, 8 (6%) were abnormal, and 1 (0.8%) was undetermined. Excluded from test performance analysis were 3 cases that were terminated without postmortem autopsy (1 was abnormal and 2 were normal), and a fourth case was excluded as it was classified as undetermined. The detection rate of esophageal atresia was 100%, with no false-positive or false-negative case. Sensitivity, specificity, and positive and negative predictive values of the dynamic esophageal patency assessment were 100%. The Kappa coefficient was 1 for both inter- and intraobserver agreements (P<.0001). The median time (interquartile range) required to complete the dynamic esophageal patency assessment was 6.00 minutes (3.00-13.25). CONCLUSION The dynamic esophageal patency assessment is a feasible and highly effective method of ascertaining an intact esophagus and detecting esophageal atresia in suspected cases.
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Bowder AN, Lal DR. Advances in the Surgical Management of Esophageal Atresia. Adv Pediatr 2021; 68:245-259. [PMID: 34243856 DOI: 10.1016/j.yapd.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alexis N Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite 320, Milwaukee, WI 53226, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite 320, Milwaukee, WI 53226, USA.
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Kassif E, Weissbach T, Kushnir A, Shust-Barequet S, Elkan-Miller T, Mazkereth R, Weissmann-Brenner A, Achiron R, Weisz B. Esophageal atresia and tracheoesophageal fistula: prenatal sonographic manifestation from early to late pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:92-98. [PMID: 32304613 DOI: 10.1002/uog.22050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Esophageal atresia and/or tracheoesophageal fistula (EA/TEF) remains one of the most frequently missed congenital anomalies prenatally. The aim of our study was to elucidate the sonographic manifestation of EA/TEF throughout pregnancy. METHODS This was a retrospective study of data obtained from a tertiary center over a 12-year period. The prenatal ultrasound scans of fetuses with EA/TEF were assessed to determine the presence and timing of detection of three principal signs: small/absent stomach and worsening polyhydramnios, both of which were considered as 'suspected' EA/TEF, and esophageal pouch, which was considered as 'detected' EA/TEF. We assessed the yield of the early (14-16 weeks' gestation), routine mid-trimester (19-26 weeks) and third-trimester (≥ 27 weeks) anomaly scans in the prenatal diagnosis of EA/TEF. RESULTS Seventy-five cases of EA/TEF with available ultrasound images were included in the study. A small/absent stomach was detected on the early anomaly scan in 3.6% of fetuses scanned, without a definitive diagnosis. On the mid-trimester scan, 19.4% of scanned cases were suspected and 4.3% were detected. On the third-trimester anomaly scan, 43.9% of scanned cases were suspected and 33.9% were detected. An additional case with an esophageal pouch was detected on magnetic resonance imaging (MRI) in the mid-trimester and a further two were detected on MRI in the third trimester. In total, 44.0% of cases of EA/TEF in our cohort were suspected, 33.3% were detected and 10.7% were suspected but, eventually, not detected prenatally. CONCLUSIONS Prenatal diagnosis of EA/TEF on ultrasound is not feasible before the late second trimester. A small/absent stomach may be visualized as early as 15 weeks' gestation. Polyhydramnios does not develop before the mid-trimester. An esophageal pouch can be detected as early as 22 weeks on a targeted scan in suspected cases. The detection rates of all three signs increase with advancing pregnancy, peaking in the third trimester. The early and mid-trimester anomaly scans perform poorly as a screening and diagnostic test for EA/TEF. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shust-Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Elkan-Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mazkereth
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Weissmann-Brenner
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hackenberg S, Kraus F, Scherzad A. Rare Diseases of Larynx, Trachea and Thyroid. Laryngorhinootologie 2021; 100:S1-S36. [PMID: 34352904 PMCID: PMC8363221 DOI: 10.1055/a-1337-5703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review article covers data on rare diseases of the larynx, the trachea and the thyroid. In particular, congenital malformations, rare manifestations of inflammatory laryngeal disorders, benign and malignant epithelial as well as non-epithelial tumors, laryngeal and tracheal manifestations of general diseases and, finally, thyroid disorders are discussed. The individual chapters contain an overview of the data situation in the literature, the clinical appearance of each disorder, important key points for diagnosis and therapy and a statement on the prognosis of the disease. Finally, the authors indicate on study registers and self-help groups.
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Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
| | - Fabian Kraus
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
| | - Agmal Scherzad
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten,
plastische und ästhetische Operationen, Universitätsklinikum
Würzburg
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8
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Weissbach T, Kassif E, Kushnir A, Shust‐Barequet S, Leibovitch L, Eliasi E, Elkan‐Miller T, Zajicek M, Yinon Y, Weisz B. Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics. Prenat Diagn 2020; 40:1418-1425. [DOI: 10.1002/pd.5785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Elior Eliasi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Elkan‐Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Zajicek
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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9
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Mégier C, Fouquet V, Senat MV, Letourneau A, Bouchghoul H. [Antenatal ultrasound prediction of esophageal atresia type]. ACTA ACUST UNITED AC 2020; 48:806-813. [PMID: 32522613 DOI: 10.1016/j.gofs.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a rare congenital malformation of the upper aerodigestive tract, which can be diagnosed antenatally in 50-65% of cases. Postnatal management differs according to the type of EA. No studies have evaluated the correlation of antenatal ultrasound findings with the type of EA. OBJECTIVE The main objective is to study the association between antenatal ultrasound signs and the type of EA. The secondary objective is to study the association between postnatal morbidity and the type of EA. METHOD We conducted a single-center retrospective study between May 2010 and August 2019. Fetuses with suspected prenatal EA and postnatal diagnosis confirmation were included. Postnatal confirmation of EA was performed during surgery for live births and by fetopathological examination for termination of pregnancy. Prenatal signs and postnatal morbidity were compared according to the type of EA. RESULTS We included 15 cases of postnatally confirmed EA, including 9 type 1EA, 5 type 3EA and 1 type 4EA (11 live births and 4 terminations of pregnancy). The gestational age at diagnosis was earlier in type 1EA: 22+0 [6-21,21-24] versus 30+0 [28+0-32+0] (P=0.03). Compared to type 3EA, type 1EA had a higher incidence of non-visible stomach bubble (89% versus 40%, P=0.09) and upper esophageal cul-de-sac dilatation (56% versus 0%, P=0.09). Neonatal morbidity in type 1EA was more severe with a longer hospital stay in neonatal intensive care. CONCLUSION The antenatal ultrasound signs seem to be more pronounced in case of type 1EA. Type 1EA is associated with severe morbidity compared to Type 3EA. Improving prenatal diagnosis of EA and its type allows a more accurate prognostic evaluation.
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Affiliation(s)
- C Mégier
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - V Fouquet
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - M V Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - A Letourneau
- Service de gynécologie obstétrique, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - H Bouchghoul
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France.
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10
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Tracy S, Buchmiller TL, Ben-Ishay O, Barnewolt CE, Connolly SA, Zurakowski D, Phelps A, Estroff JA. The Distended Fetal Hypopharynx: A Sensitive and Novel Sign for the Prenatal Diagnosis of Esophageal Atresia. J Pediatr Surg 2018; 53:1137-1141. [PMID: 29622396 DOI: 10.1016/j.jpedsurg.2018.02.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND/PURPOSE Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach). METHODS We retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis. RESULTS Seventy-five women had 107 study visits (range 1-4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28weeks of gestation, DHP had a predictive accuracy for EA of 0.929 (P=0.001). CONCLUSIONS DHP is a sensitive additional prenatal sign of EA. More accurate diagnosis of EA allows for improved counseling regarding delivery, postnatal evaluation, and surgical correction. TYPE OF STUDY Diagnostic. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Boston, MA.
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | - Offir Ben-Ishay
- Department of General Surgery, Ramban Health Care Campus, Haifa, Israel
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | | | - Andrew Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
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11
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Fusco JC, Calisto JL, Gaines BA, Malek MM. A large single-institution review of tracheoesophageal fistulae with evaluation of the use of transanastomotic feeding tubes. J Pediatr Surg 2017; 53:S0022-3468(17)30648-6. [PMID: 29113678 DOI: 10.1016/j.jpedsurg.2017.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transanastomatic feeding tube (TAT) use in the repair of tracheoesophageal fistulas (TEF) with or without esophageal atresia (EA) and EA with or without TEF allows for earlier enteral feedings, however, may predispose to esophageal stricture. METHODS We review our institutional experience with esophageal atresia repair over a 15-year period from 2000 to 2015 and report on our observed complication rate with emphasis on the surgical approach and use of TATs. RESULTS We identified 110 TEF repairs. Ninety-six were Type C, 7 were Type A, 4 were Type D, and 3 were Type E (H-Type). TATs were used in 74% of patients. The stricture rate with the TAT approached 56% versus 17% without a TAT (p<0.0005). There was no difference in leak rate (p=0.27). Ninety-four TEF repairs were performed via open thoracotomy, and 16 were initially approached thoracoscopically. Six out of 16 that were started thoracoscopically were completed with the minimally invasive approach. Whether the case was started thoracoscopically, completed thoracoscopically, or performed open made no difference in the rate of stricture or anastomotic leak, but we did observe an increase in musculoskeletal complications in the open thoracotomy group (28% vs. 0). CONCLUSION Our data suggests that the use of TATs does not protect against anastomotic leak, but may increase stricture rate. Further, the thoracoscopic group showed no difference in the leak or stricture rate and demonstrated less musculoskeletal complications. Confirmation of these findings will require a prospective study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joseph C Fusco
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC; Department of Surgery, University of Pittsburgh School of Medicine
| | - Juan L Calisto
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC; Department of Surgery, University of Pittsburgh School of Medicine
| | - Barbara A Gaines
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC; Department of Surgery, University of Pittsburgh School of Medicine
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC; Department of Surgery, University of Pittsburgh School of Medicine.
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12
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Stoll C, Alembik Y, Dott B, Roth MP. Associated anomalies in cases with esophageal atresia. Am J Med Genet A 2017; 173:2139-2157. [DOI: 10.1002/ajmg.a.38303] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/25/2017] [Accepted: 05/06/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Claude Stoll
- Genetique Medicale; Faculte de Medecine; Strasbourg France
| | - Yves Alembik
- Genetique Medicale; Faculte de Medecine; Strasbourg France
| | - Beatrice Dott
- Genetique Medicale; Faculte de Medecine; Strasbourg France
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13
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el-shafy IA, Prince JM. Thoracoscopic Repair of Esophageal Atresia and Tracheoesophageal Fistula. THE SAGES MANUAL OF PEDIATRIC MINIMALLY INVASIVE SURGERY 2017:171-177. [DOI: 10.1007/978-3-319-43642-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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14
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Demikova NS, Vydrych YV, Podolnaya MA, Lapina AS, Asanov AY. Prevalence and descriptive epidemiology of esophageal atresia in the Russian Federation. ACTA ACUST UNITED AC 2016; 106:854-859. [PMID: 27601140 DOI: 10.1002/bdra.23553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/21/2016] [Accepted: 07/08/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study examined the prevalence of esophageal atresia (EA) and the relationship between EA and demographic factors in the Russian Federation. METHODS Data were obtained from a population-based congenital malformations registry across 14 years (2000-2013) in 24 regions of the Russian Federation and included cases of EA among live births and stillbirths. RESULTS The total number of births was 6,478,706. There were 1317 cases of isolated EA, resulting in a rate of 2.03 (95% confidence interval [CI], 1.92-2.15) per 10,000 births or 1 case per 4926 births. There were differences in the prevalence of EA among regional registries of the Russian Federation. The prevalence of EA during the study period was stable. 57.3% of all cases were cases of EA with tracheo-esophageal fistula (compared with 42.7% of cases without fistula). The male/female sex ratio was 1.3. The relative risk of EA was higher for live births with birth weight less than 3000 g (relative risk [RR] = 2.58 (95% CI, 2.36-2.82), for older maternal age (RR = 1.47 (95% CI, 1.24-1.75), for males (RR = 1.09; 95% CI, 1.03-1.17), and for the first gravidity (RR = 1.17; 95% CI, 1.09-1.25). CONCLUSION In this study, the prevalence of EA across different regions of the Russian Federation was analyzed. The prevalence of EA in the period under study remained stable, and the relative risk of EA was associated with maternal age, birth weight and gravidity. Birth Defects Research (Part A) 106:854-859, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nataliya S Demikova
- Pirogov Russian National Research Medical University, Research Clinical Institute of Pediatric, Moscow, Russia.
| | - Yulia V Vydrych
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marina A Podolnaya
- Pirogov Russian National Research Medical University, Research Clinical Institute of Pediatric, Moscow, Russia
| | - Aleksandra S Lapina
- Pirogov Russian National Research Medical University, Research Clinical Institute of Pediatric, Moscow, Russia
| | - Aliy Yu Asanov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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15
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Hart NA, Osborne N, Liversedge H. QUESTION 1: Should the passage of a nasogastric tube be universal to all babies born to mothers with polyhydramnios or targeted to those with additional findings on ultrasound? Arch Dis Child 2016; 101:866-8. [PMID: 27540183 DOI: 10.1136/archdischild-2016-311117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/13/2016] [Indexed: 11/04/2022]
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16
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Bradshaw CJ, Thakkar H, Knutzen L, Marsh R, Pacilli M, Impey L, Lakhoo K. Accuracy of prenatal detection of tracheoesophageal fistula and oesophageal atresia. J Pediatr Surg 2016; 51:1268-72. [PMID: 26932255 DOI: 10.1016/j.jpedsurg.2016.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/06/2016] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
AIMS This study aims to determine the rate of prenatal detection of tracheoesophageal fistula and oesophageal atresia (TOF/OA), by identifying a small or absent stomach bubble with or without polyhydramnios, on the prenatal ultrasound scans (USS). METHODS A retrospective study of prenatal ultrasound findings of babies with a prenatal and postnatal diagnosis of TOF/OA born between 1st January 2004 and 31st December 2013 was undertaken. RESULTS A total of 58 babies were born with TOF/OA. 40% of mothers had their prenatal investigations performed within our tertiary centre, and the remaining 60% had their antenatal care at their local district general hospital (DGH). The overall sensitivity for prenatal USS was 26%, with a specificity of 99% and a positive predictive value (PPV) of 35%. However, the sensitivity of the prenatal USS within the tertiary centre was significantly higher at 57%, while only 2 cases were detected prenatally in the DGHs. Polyhydramnios was seen in 67% of mothers that had a prenatal diagnosis of TOF/OA and its presence did significantly increase the positive predictive value of prenatal USS (from 35% to 63%). Of those that were postnatally diagnosed, 21% had prenatal polyhydramnios. There was no significant difference in postnatal outcomes between those that were prenatally diagnosed and those that were postnatally diagnosed. CONCLUSION Prenatal diagnosis of TOF/OA remains challenging. However within a specialist centre the accuracy of successful prenatal detection can be significantly improved. This is beneficial both for prenatal counselling of families and for planning appropriate perinatal and postnatal care for the baby.
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Affiliation(s)
- Catherine J Bradshaw
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
| | - Hemanshoo Thakkar
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Liz Knutzen
- Department of Fetal Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Rachel Marsh
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Laurence Impey
- Department of Fetal Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Kokila Lakhoo
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
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17
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Roberts K, Karpelowsky J, Fitzgerald DA, Soundappan SS. Outcomes of oesophageal atresia and tracheo-oesophageal fistula repair. J Paediatr Child Health 2016; 52:694-8. [PMID: 27206060 DOI: 10.1111/jpc.13211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/31/2022]
Abstract
Oesophageal atresia and tracheo-oesophageal fistula are congenital anomalies of the oesophagus requiring surgical repair in infancy, either by open or thoracoscopic approach. Although mortality rates associated with this procedure are low, children may go on to have complications throughout childhood and into adulthood, most commonly related to ongoing gastrointestinal and respiratory symptoms. This review outlines the early, mid and long-term outcomes for these children in terms of quality of life and incidence of symptoms.
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Affiliation(s)
- Kiera Roberts
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Karpelowsky
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, The Children's Hospital Westmead, Sydney, New South Wales, Australia
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18
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Cassina M, Ruol M, Pertile R, Midrio P, Piffer S, Vicenzi V, Saugo M, Stocco CF, Gamba P, Clementi M. Prevalence, characteristics, and survival of children with esophageal atresia: A 32-year population-based study including 1,417,724 consecutive newborns. ACTA ACUST UNITED AC 2016; 106:542-8. [PMID: 26931365 DOI: 10.1002/bdra.23493] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a congenital malformation of the upper gastrointestinal tract with an estimated prevalence varying from 1 in 2500 to 1 in 4500 births. The aim of this study was to describe the epidemiology of EA between 1981 and 2012 and evaluate patients' survival. METHODS This study used data from a population-based Italian Congenital Malformation Registry. The survival status was ascertained by linking the registry records, vital records and the regional registries of patients. Kaplan-Meier methods were used to estimate survival probabilities up to 25 years and Cox proportional hazards regression was used to evaluate factors that affected survival. RESULTS A total of 407 cases of EA were identified among 1,417,724 total births. After the exclusion of cases with chromosomal anomalies, 49.9% of the patients presented with at least one associated congenital anomaly. The 25-year survival probability was 85.1% (95% confidence interval [CI], 80.8-89.4), with most deaths occurring during the first months of life. Patients' characteristics associated with decreased survival probability were low birth weight (hazard ratio, 3.7; 95% CI, 1.7-8.3) and presence of additional major defects (hazard ratio, 2.8; 95% CI, 1.3-6.0). A significant improvement in survival over the decades was observed for patients with nonisolated EA. CONCLUSION This study detected a significant improvement in survival of individuals with EA over the past decades and identified the strongest predictors of mortality. These results will be important for the planning of the clinical management and formulation of prognosis when EA is diagnosed in a newborn. Birth Defects Research (Part A) 106:542-548, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matteo Cassina
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Michele Ruol
- Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Paola Midrio
- Pediatric Surgery Unit, "Ca' Foncello" Hospital, Treviso, Italy
| | - Silvano Piffer
- Epidemiological Department, Trento Province, Trento, Italy
| | - Virginia Vicenzi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Mario Saugo
- Regional Epidemiological Department, Veneto Region, Padova, Italy
| | | | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
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19
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Sadreameli SC, McGrath-Morrow SA. Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia. Paediatr Respir Rev 2016; 17:16-23. [PMID: 25800226 PMCID: PMC4559488 DOI: 10.1016/j.prrv.2015.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.
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20
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Garabedian C, Sfeir R, Langlois C, Bonnard A, Khen-Dunlop N, Gelas T, Michaud L, Auber F, Piolat C, Lemelle JL, Fouquet V, Habonima É, Becmeur F, Polimerol ML, Breton A, Petit T, Podevin G, Lavrand F, Allal H, Lopez M, Elbaz F, Merrot T, Michel JL, Buisson P, Sapin E, Delagausie P, Pelatan C, Gaudin J, Weil D, de Vries P, Jaby O, Lardy H, Aubert D, Borderon C, Fourcade L, Geiss S, Breaud J, Pouzac M, Echaieb A, Laplace C, Gottrand F, Houfflin-Debarge V. Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ? ACTA ACUST UNITED AC 2015; 44:848-54. [DOI: 10.1016/j.jgyn.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/09/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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21
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Leoncini E, Bower C, Nassar N. Oesophageal atresia and tracheo-oesophageal fistula in Western Australia: Prevalence and trends. J Paediatr Child Health 2015; 51:1023-9. [PMID: 25976171 DOI: 10.1111/jpc.12909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 01/14/2023]
Abstract
AIM A recent international study reported a higher prevalence of oesophageal atresia with or without tracheo-oesophageal fistula (OA±TOF) in Western Australia (WA). The aim of this study was to examine the prevalence and trends of OA and/or TOF in WA, determine the proportion of cases with associated anomalies and explore the impact of time of diagnosis. METHODS The study population comprised all infants born in WA, 1980-2009, and registered with OA and/or TOF on the WA Register of Developmental Anomalies (WARDA). RESULTS OA±TOF and TOF alone affect, on average, one in every 2927 births in WA, with a total prevalence of 3.00 and 0.42 per 10 000 births, respectively. The prevalence of OA±TOF increased by 2.0% per annum, with only cases with associated anomalies (64% of cases) demonstrating an increase. TOF rates were stable. Among OA±TOF infants, the proportion of live births, stillbirths and elective terminations of pregnancy for fetal anomaly (TOPFA) was 79%, 6% and 15%, respectively, whereas the majority (94%) of TOF only cases were live births. In 2000-2009, there was 30% fall in OA±TOF live births with 61 (58%) cases diagnosed in first week of life, 10 (9%) prenatally and 34 (32%) at post-mortem only. CONCLUSIONS A higher prevalence of OA±TOF in WA was observed with increase over time attributable to increase with associated anomalies. Consistent reporting, availability of prenatal diagnosis and ascertainment of cases following TOPFA or post-mortem examinations can significantly affect prevalence of OA and/or TOF.
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Affiliation(s)
- Emanuele Leoncini
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia
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22
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Pini Prato A, Carlucci M, Bagolan P, Gamba PG, Bernardi M, Leva E, Paradies G, Manzoni C, Noccioli B, Tramontano A, Jasonni V, Vaccarella F, De Pascale S, Alberti D, Riccipetitoni G, Falchetti D, Caccia F, Pelizzo G, Schleef J, Lima M, Andriolo P, Franchella A, Cacciari A, Caravaggi F, Federici S, Andermarcher M, Perrino G, Codrich D, Camoglio FS, Chiarenza FS, Martino A, Appignani A, Briganti V, Caterino S, Cozzi D, Messina M, Rizzo A, Liotta L, Salerno D, Aceti MGR, Bartoli F, Romeo C, Esposito C, Lelli Chiesa PL, Clemente E, Mascia L, Cacciaguerra S, Di Benedetto V, Licciardi S, De Grazia E, Ubertazzi M, Piazza G, Mattioli G, Rossi F, Nobili M. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:1441-56. [PMID: 25783403 DOI: 10.1016/j.jpedsurg.2015.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
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Affiliation(s)
| | - M Carlucci
- Istituto Giannina Gaslini, Genova, Italy
| | - P Bagolan
- Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - P G Gamba
- Azienda Ospedaliero-Universitaria, Padova, Italy
| | - M Bernardi
- Azienda Ospedaliera della Provincia di Lecco, Merate, Italy
| | - E Leva
- Ospedale Maggiore Policlinico Magiagalli, Milano, Italy
| | | | | | - B Noccioli
- Ospedale Pediatrico Meyer, Firenze, Italy
| | - A Tramontano
- Azienda Ospedaliera Pediatrica Santobono Pausilipon, Napoli, Italy
| | - V Jasonni
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - F Vaccarella
- ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | | | | | - F Caccia
- Ospedale San Carlo Borromeo, Milano
| | | | - J Schleef
- Ospedale Infantile Regina Margherita, Torino
| | - M Lima
- Ospedale Sant'Orsola Malpighi, Bologna
| | | | | | | | | | | | | | | | - D Codrich
- Ospedale Infantile Burlo Garofalo, Trieste
| | | | | | | | - A Appignani
- Ospedale Santa Maria della Misericordia, Perugia
| | | | | | | | - M Messina
- Ospedale Policlinico Santa Maria alle Scotte, Siena
| | | | - L Liotta
- Ospedale Francesco Ferrari, Casarano
| | - D Salerno
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | - F Bartoli
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
| | - C Romeo
- Azienda Ospedaliero-Universitaria G. Martino, Messina
| | - C Esposito
- Policlinico Universitario Federico II, Napoli
| | | | - E Clemente
- Azienda Ospedaliera Universitaria S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | - E De Grazia
- Azienda Ospedaliero-Universitaria Policlinico P. Giaccone
| | | | - G Piazza
- Ospedale Sant'Antonio Abate, Trapani
| | | | - F Rossi
- Ospedale Maggiore della carità, Novara
| | - M Nobili
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
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Fall M, Mbaye PA, Horace HJ, Wellé IB, Lo FB, Traore MM, Diop M, Ndour O, Ngom G. Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal. Afr J Paediatr Surg 2015; 12:187-90. [PMID: 26612124 PMCID: PMC4955436 DOI: 10.4103/0189-6725.170196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. PATIENTS AND METHODS We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. RESULTS The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. CONCLUSION The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.
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Affiliation(s)
- Mbaye Fall
- Department of Pediatric Surgery, Albert Royer Children Hospital, Dakar, Senegal
| | - Papa Alassane Mbaye
- Departement of Pediatric Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | - Faty Balla Lo
- Department of Pediatric Surgery, Albert Royer Children Hospital, Dakar, Senegal
| | - Mamadou Mour Traore
- Department of Pediatric Surgery, Albert Royer Children Hospital, Dakar, Senegal
| | - Marie Diop
- Department of Pediatric Surgery, Albert Royer Children Hospital, Dakar, Senegal
| | - Oumar Ndour
- Departement of Pediatric Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Gabriel Ngom
- Departement of Pediatric Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
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Right thoracotomy approach for patients with congenital tracheoesophageal fistula associated with right-sided aortic arch. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000462664.82660.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia? Am J Obstet Gynecol 2015; 212:340.e1-7. [PMID: 25265404 DOI: 10.1016/j.ajog.2014.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA. STUDY DESIGN We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year. RESULTS Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001). CONCLUSION Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
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Takahashi D, Hiroma T, Takamizawa S, Nakamura T. Population-based study of esophageal and small intestinal atresia/stenosis. Pediatr Int 2014; 56:838-844. [PMID: 24730728 DOI: 10.1111/ped.12359] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to describe the prevalence of esophageal atresia/stenosis and small intestinal atresia/stenosis in Nagano, Japan, together with associated anomalies, prenatal diagnosis and survival. METHODS A population-based cohort study of the prevalence of esophageal atresia/stenosis and small intestinal atresia/stenosis was conducted in Nagano in January 1993-December 2011. The Mann-Whitney test, χ(2) test and Kruskal-Wallis test were used to compare variables. P < 0.05 was considered statistically significant. RESULTS In total, 74 cases of esophageal atresia/stenosis and 87 cases of small intestinal atresia/stenosis (31 duodenal, 56 jejuno-ileal) were identified. Prevalences were 1.97 for esophageal atresia/stenosis and 2.23 for small intestinal atresia/stenosis (0.83 for duodenal atresia/stenosis and 1.49 for jejuno-ileal atresia/stenosis) per 10,000 births, respectively. The prevalence of esophageal atresia/stenosis increased significantly from 1993-2001 to 2002-2011 (relative risk [RR], 1.6), as did the prevalences of duodenal atresia/stenosis (RR, 2.2) and jejuno-ileal atresia/stenosis (RR, 3.1). Chromosomal anomalies, particularly trisomy 21, were seen significantly more often in association with duodenal atresia/stenosis (55%) than with esophageal atresia/stenosis (28%, P < 0.01) or jejuno-ileal atresia/stenosis (2%, P < 0.01). The proportion of patients associated with prenatally diagnosed chromosomal anomaly was higher compared to postnatal diagnosis (P < 0.01) in the esophageal atresia/stenosis group. CONCLUSION The prevalence of esophageal and small intestinal atresia/stenosis increased significantly from 1993-2001 to 2002-2011. Prenatally diagnosed esophageal atresia/stenosis is associated with multiple anomalies, particularly chromosomal anomalies, compared to other small intestine atresia/stenosis.
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Affiliation(s)
- Daijiro Takahashi
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan.,Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
| | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
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Kunisaki SM, Bruch SW, Hirschl RB, Mychaliska GB, Treadwell MC, Coran AG. The diagnosis of fetal esophageal atresia and its implications on perinatal outcome. Pediatr Surg Int 2014; 30:971-7. [PMID: 25056797 DOI: 10.1007/s00383-014-3562-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/24/2022]
Abstract
The current diagnostic accuracy and perinatal outcome of fetuses with esophageal atresia (EA) continues to be debated. In this review, we report on our experience at a tertiary care fetal center with the prenatal ultrasound diagnosis of EA. Enrollment criteria included a small/absent stomach bubble with a normal or elevated amniotic fluid index between 2005 and 2013. Perinatal outcomes were analyzed and compared to postnatally diagnosed EA cases. Of the 22 fetuses evaluated, polyhydramnios occurred in 73%. Three (14%) died in utero or shortly after birth, but none had EA. In the presence of an absent/small stomach and polyhydramnios, the positive predictive value for EA was 67%. In fetal EA cases confirmed postnatally (group 1, n = 11), there were no differences in gestational age, birthweight, or mortality when compared to postnatally diagnosed infants (group 2, n = 59). Group 1 was associated with long-gap EA, need for esophageal replacement, and increased hospital length of stay. When taken in context with the current literature, we conclude that ultrasound findings suggestive of EA continue to be associated with a relatively high rate of false positives. However, among postnatally confirmed cases, there is an increased risk for long-gap EA and prolonged hospitalization.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 E. Hospital Drive, SPC 4211, Ann Arbor, MI, 48109, USA,
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Demographic characteristics in patients with short-gap and long-gap esophageal atresia. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000452066.08719.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Ethun CG, Fallon SC, Cassady CI, Mehollin-Ray AR, Olutoye OO, Zamora IJ, Lee TC, Welty SE, Cass DL. Fetal MRI improves diagnostic accuracy in patients referred to a fetal center for suspected esophageal atresia. J Pediatr Surg 2014; 49:712-5. [PMID: 24851753 DOI: 10.1016/j.jpedsurg.2014.02.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to describe prenatal imaging characteristics and outcomes of fetuses with suspected esophageal atresia (EA) in order to improve prenatal diagnosis, counseling, and management. METHODS The medical records of all patients referred to our multidisciplinary fetal center for suspected EA from January 2003 to April 2013 were reviewed retrospectively. RESULTS Thirty-three patients were referred with a prenatal diagnosis of possible EA. Following fetal center evaluation with MRI, EA was deemed unlikely in 6 (18%) fetuses. Of 27 fetuses in whom EA could not be excluded, EA was confirmed postnatally in 15 (56%), excluded in 7 (26%), and unconfirmed in 5 (3 fetal losses; 2 lost to follow-up). Imaging characteristics on fetal MRI associated with the highest positive predictive values (PPV) were an esophageal pouch (100%) and a small stomach (75%). The finding of polyhydramnios had high sensitivity (93%) but low specificity (31%) and PPV (61%) for a diagnosis of EA. CONCLUSION Prenatal imaging and fetal center evaluation correctly identify the presence or absence of esophageal atresia in 78% of patients referred on suspicion of this condition. The presence of an esophageal pouch on fetal MRI has significant predictive value for EA. These data may assist with evidence-based prenatal family counseling.
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Affiliation(s)
- Cecilia G Ethun
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sara C Fallon
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christopher I Cassady
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Irving J Zamora
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Timothy C Lee
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Stephen E Welty
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, Texas
| | - Darrell L Cass
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Garabedian C, Verpillat P, Czerkiewicz I, Langlois C, Muller F, Avni F, Bigot J, Sfeir R, Vaast P, Coulon C, Subtil D, Houfflin-Debarge V. Does a combination of ultrasound, MRI, and biochemical amniotic fluid analysis improve prenatal diagnosis of esophageal atresia? Prenat Diagn 2014; 34:839-42. [DOI: 10.1002/pd.4376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/31/2014] [Accepted: 03/31/2014] [Indexed: 11/10/2022]
Affiliation(s)
- C. Garabedian
- Department of Obstetrics; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - P. Verpillat
- Department of Pediatric Radiology; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - I. Czerkiewicz
- Biochemistry-Hormonology Department, Robert Debré Hospital, AP-HP; University Paris Ile de France Ouest; Paris France
| | - C. Langlois
- Department of Biostatistics, EA2694, UDSL; University of Lille Nord de France, CHRU de Lille; Lille France
| | - F. Muller
- Biochemistry-Hormonology Department, Robert Debré Hospital, AP-HP; University Paris Ile de France Ouest; Paris France
| | - F. Avni
- Department of Pediatric Radiology; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - J. Bigot
- Department of Pediatric Radiology; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - R. Sfeir
- Reference Center for Congenital Esophageal Abnormalities (CRACMO); Lille France
| | - P. Vaast
- Department of Obstetrics; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - C. Coulon
- Department of Obstetrics; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
| | - D. Subtil
- Department of Obstetrics; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
- University of Lille Nord de France; Lille France
| | - V. Houfflin-Debarge
- Department of Obstetrics; Jeanne de Flandre Hospital, CHRU de Lille; Lille France
- University of Lille Nord de France; Lille France
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Garabedian C, Vaast P, Bigot J, Sfeir R, Michaud L, Gottrand F, Verpillat P, Coulon C, Subtil D, Houfflin Debarge V. [Esophageal atresia: prevalence, prenatal diagnosis and prognosis]. ACTA ACUST UNITED AC 2014; 43:424-30. [PMID: 24440126 DOI: 10.1016/j.jgyn.2013.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/10/2013] [Accepted: 11/19/2013] [Indexed: 01/29/2023]
Abstract
Esophageal atresia (EA) is a rare congenital malformation (1 in 2,500 to 3,500 births). Prenatal diagnosis (PN) is particularly interesting allowing search for associated malformations related to worse prognosis forms (reference ultrasound, MRI and amniocentesis) and planning the birth in an adapted medico-surgical center. Diagnosis of EA is usually suspected because of indirect and non-specific signs: association of polyhydramnios and absent or small stomach bubble. The visualization in ultrasound or MRI of cervical or thoracic fluid image corresponding to the expansion of the bottom of upper esophageal ("pouch sign") increases the specificity of diagnosis. However, prenatal diagnosis remains difficult and less than 50 % of EA are diagnosed prenatally. Biochemical analysis could improve these results. If EA is confirmed at birth, surgical management consists in a primary end-to-end anastomosis in first days of life, or in two-steps surgery if the defect is too large. Although current prognosis of EA is good, frequency of surgical complications and esophageal lesions secondary to gastroesophageal reflux justify a systematic and multidisciplinary extended follow-up.
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Affiliation(s)
- C Garabedian
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - P Vaast
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - J Bigot
- Service d'imagerie de la femme, pôle de radiologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France
| | - R Sfeir
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France
| | - L Michaud
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - F Gottrand
- Centre de référence des affections congénitales et malformatives de l'œsophage, hôpital Jeanne-de-Flandre, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - P Verpillat
- Service d'imagerie de la femme, pôle de radiologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France
| | - C Coulon
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - D Subtil
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
| | - V Houfflin Debarge
- Pôle femme-mère-nouveau-né, clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille, France; Université Lille Nord de France, 59037 Lille, France
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32
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Specific biochemical amniotic fluid pattern of fetal isolated esophageal atresia. Pediatr Res 2013; 74:601-5. [PMID: 23942557 DOI: 10.1038/pr.2013.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 02/10/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Perinatal care of esophageal atresia (EA) may be improved by prenatal diagnosis. Ultrasound findings (polyhydramnios and/or nonvisualization of fetal stomach) lead to a detection rate of ~50%. An amniotic fluid (AF) biochemical pattern characterized by high total protein, γ-glutamyl transpeptidase (GGTP), and normal l-leucine-aminopeptidase (AMP) leads to a 100% detection rate. The aim of this study was to explain this specific pattern. METHODS On the basis of enzyme activities assay, the following four objectives were sought: (i) comparing AF markers between EA and other digestive tract atresias, (ii) determining local GGTP synthesis in the esophagus (immunohistobiochemistry), (iii) determining the presence of a specific AF-AMP activity inhibitor, and (iv) comparing AF-AMP and AF-GGTP half-lives. RESULTS The AF-EA pattern was similar to that observed in upper duodenal atresia (above the Oddi sphincter). No local synthesis of GGTP was observed in the esophagus. No AF-AMP activity inhibitor was found. AF-GGTP had a longer half-life than AF-AMP. CONCLUSION Due to the swallowing anomaly observed in EA, GGTP and AMP values physiologically observed at 18 wk will decrease on the basis of the half-lives of markers, with a flat slope for GGTP and a sharp slope for AMP, therefore explaining the differences observed in the AF-EA pattern.
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Kuti K, Patel R, Chapman S, Jawaheer G. A rare pitfall in the diagnosis of oesophageal atresia. Pediatr Radiol 2013; 43:902-4. [PMID: 20461367 DOI: 10.1007/s00247-010-1685-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
Abstract
The diagnosis of oesophageal atresia (OA) is usually made soon after birth. Two diagnostic criteria are failure to pass a nasogastric (NG) tube and a chest radiograph demonstrating a curled NG tube in the upper oesophageal pouch. A 6-day-old neonate was referred to our institution with persistence of symptoms following exclusion of the diagnosis of OA on the basis of an NG tube radiologically confirmed to reach the stomach. Persistent oxygen desaturations and copious salivation led to further investigations, and a delayed diagnosis of oesophageal atresia and tracheo-oesophageal fistula was made. Radiological demonstration of an NG tube reaching the stomach does not exclude the diagnosis of oesophageal atresia and can be falsely reassuring and lead to diagnostic delay.
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Affiliation(s)
- Kamal Kuti
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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Kumar M, Sharma S, Bhagat M, Gupta U, Anand R, Puri A, Singh A, Singh A. Postnatal outcome of congenital anomalies in low resource setting. Prenat Diagn 2013; 33:983-9. [DOI: 10.1002/pd.4179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/02/2013] [Accepted: 06/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Manisha Kumar
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Sumedha Sharma
- Department of Obstetrics & Gynaecology; All India Institute of Medical sciences; New Delhi India
| | - Manisha Bhagat
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Usha Gupta
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Rama Anand
- Department of Radiology; Lady Hardinge Medical College; New Delhi India
| | - Archana Puri
- Department of Paediatric Surgery; Lady Hardinge Medical College; New Delhi India
| | - Anuradha Singh
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Abha Singh
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
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Caplan A. Psychological impact of esophageal atresia: review of the research and clinical evidence. Dis Esophagus 2013; 26:392-400. [PMID: 23679030 DOI: 10.1111/dote.12056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal atresia (EA) occurs in one out of 2500 to 4500 live births. As the vast majority of infants are now surviving neonatal corrective surgery, the focus has shifted from mortality to morbidity associated with EA. However, little is known about its psychological morbidity. This paper synthesizes research and clinical evidence to highlight the psychological sequelae of EA, including its impact on parents' psychological functioning and its effects on child development from infancy to adulthood. Whether it is discovered at birth or prenatally, EA is a psychologically traumatic event, and parents are at risk for developing traumatic stress reactions following diagnosis. Neonatal surgery and intensive care, risk of complications, associated anomalies, and genetic etiologies multiply risk for parents' acute and post-traumatic stress disorders (PTSD). Parental PTSD has a negative impact on infant and child development through its effects on parenting skills and parent-child interactions. EA children are also at risk for PTSD because of invasive and stressful procedures they undergo during the neonatal period. Consequences of EA can have an important long-term impact on children's psychological and social development. The scant studies pertaining to cognitive functioning suggest that EA does not affect mental development during infancy, but may be associated with deficits as children reach school age. Long-term sequelae are unclear because psychological functioning in adults has not yet been adequately examined. Research and clinical evidence of psychological morbidity associated with EA has implications for clinical practice. Psychological support for parents must begin during the neonatal period and should continue as an integral component of long-term follow up for both children and parents. Support is best provided within the context of a multidisciplinary treatment team that follows patients from birth through childhood and adolescence. Psychological follow up should continue into adulthood, as patients grow up and transition from pediatric to adult health-care settings.
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Affiliation(s)
- A Caplan
- Division of Gastroenterology, Hepatology, and Nutrition, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.
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36
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Burge DM, Shah K, Spark P, Shenker N, Pierce M, Kurinczuk JJ, Draper ES, Johnson PRV, Knight M. Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg 2013; 100:515-21. [DOI: 10.1002/bjs.9019] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Reports on the management and outcome of rare conditions, such as oesophageal atresia, are frequently limited to case series reporting single-centre experience over many years. The aim of this study was to identify all infants born with oesophageal atresia in the UK and Ireland to describe current clinical practice and outcomes.
Methods
This was a prospective multicentre cohort study of all infants born with oesophageal atresia and/or tracheo-oesophageal fistula in 2008–2009 in the UK and Ireland to record current clinical management and early outcomes.
Results
A total of 151 infants admitted to 28 paediatric surgical units were identified. Some aspects of perioperative management were universal, including oesophageal decompression, operative technique and the use of transanastomotic tubes. However, there were a number of areas where clinical practice varied considerably, including the routine use of perioperative chest drains, postoperative contrast studies and antireflux medication, with each of these being employed in 30–50 per cent of patients. There was a trend towards routine postoperative ventilation.
Conclusion
The prospective methodology used in this study can help identify practices that all surgeons employ and also those that few surgeons use. Areas of clinical equipoise can be recognized and avenues for further research identified.
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Affiliation(s)
- D M Burge
- Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Shah
- Department of Paediatric Surgery, Oxford, UK
| | - P Spark
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - N Shenker
- Department of Paediatric Surgery, Oxford, UK
| | - M Pierce
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - E S Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Nassar N, Leoncini E, Amar E, Arteaga-Vázquez J, Bakker MK, Bower C, Canfield MA, Castilla EE, Cocchi G, Correa A, Csáky-Szunyogh M, Feldkamp ML, Khoshnood B, Landau D, Lelong N, López-Camelo JS, Lowry RB, McDonnell R, Merlob P, Métneki J, Morgan M, Mutchinick OM, Palmer MN, Rissmann A, Siffel C, Sìpek A, Szabova E, Tucker D, Mastroiacovo P. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. ACTA ACUST UNITED AC 2012; 94:893-9. [PMID: 22945024 DOI: 10.1002/bdra.23067] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012.
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Affiliation(s)
- Natasha Nassar
- Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Australia
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Kunisaki SM, Foker JE. Surgical advances in the fetus and neonate: esophageal atresia. Clin Perinatol 2012; 39:349-61. [PMID: 22682384 DOI: 10.1016/j.clp.2012.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article focuses on selected topics in the diagnosis and management of patients with esophageal atresia (EA) with or without tracheoesophageal fistula. The current status of prenatal diagnosis and recent advances in surgical techniques, including thoracoscopic repair for short-gap EA and tension-induced esophageal growth for long-gap EA, are reviewed. Although no consensus exists among pediatric surgeons regarding the role of these procedures in the treatment of EA, one can reasonably expect that, as they evolve, their application will become more widespread in this challenging patient population.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Fetal Diagnosis and Treatment Center, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Medical School, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48109, USA.
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Abstract
Foetal counselling is best achieved by a multidisciplinary team that can favourably influence the perinatal management of prenatally diagnosed anomalies and provide this information to prospective parents. Prenatal diagnosis has remarkably improved our understanding of surgically correctable congenital malformations. It has allowed us to influence the delivery of the baby, offer prenatal surgical management and discuss the options of termination of pregnancy for seriously handicapping or lethal conditions. Antenatal diagnosis has also defined an in utero mortality for some lesions such as diaphragmatic hernia and sacrococcygeal teratoma so that true outcomes can be measured. The limitation of in-utero diagnosis cannot be ignored. The aim of prenatal counselling is to provide information to prospective parents on foetal outcomes, possible interventions, appropriate setting, time and route of delivery and expected postnatal outcomes, immediate and long term.
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Affiliation(s)
- Kokila Lakhoo
- Children's Hospital Oxford, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford, United Kingdom.
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Sistonen SJ, Pakarinen MP, Rintala RJ. Long-term results of esophageal atresia: Helsinki experience and review of literature. Pediatr Surg Int 2011; 27:1141-9. [PMID: 21960312 DOI: 10.1007/s00383-011-2980-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2011] [Indexed: 01/16/2023]
Abstract
Esophageal atresia (EA) affects one in 2,840 newborns, and over half have associated anomalies that typically affect the midline. After EA repair in infancy, gastroesophageal reflux (GER) and esophageal dysmotility and respiratory problems are common. Significant esophageal morbidity associated with EA extends into adulthood. Surgical complications, increasing age, and impaired esophageal motility predict the development of epithelial metaplasia after repair of EA. To date, worldwide, six cases of esophageal cancer have been reported in young adults treated for EA. According to our data, the statistical risk for esophageal cancer is not higher than 500-fold that of the general population. However, the overall cancer incidence among adults with repaired EA does not differ from that of the general population. Adults with repaired EA have had significantly more respiratory symptoms and infections, as well as more asthma and allergies than does the general population. Nearly half the patients have bronchial hyperresponsiveness. Thoracotomy-induced rib fusion and gastroesophageal reflux-associated columnar epithelial metaplasia are the most significant risk factors for the restrictive ventilatory defect that occurs in over half the patients. Over half the patients with repaired EA are likely to develop scoliosis. Risk for scoliosis is 13-fold after repair of EA in relation to that of the general population. Nearly half of the patients have had vertebral anomalies predominating in the cervical spine, and of these, most were vertebral fusions. The natural history of spinal deformities seems, however, rather benign, with spinal surgery rarely indicated.
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Affiliation(s)
- Saara J Sistonen
- Department of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
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41
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Czerkiewicz I, Dreux S, Beckmezian A, Benachi A, Salomon LJ, Schmitz T, Bonnard A, Khen-Dunlop N, Muller F. Biochemical amniotic fluid pattern for prenatal diagnosis of esophageal atresia. Pediatr Res 2011; 70:199-202. [PMID: 21522036 DOI: 10.1203/pdr.0b013e318220c08a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prenatal diagnosis of esophageal atresia (EA) may improve the outcome of affected neonates by allowing optimization of both prenatal and postnatal care. Prenatal sonographic detection is based on polyhydramnios and/or nonvisualization of the fetal stomach bubble, two signs with a large number of etiologies. We evaluated a biochemical approach to improving diagnostic efficiency. We compared amniotic fluid biochemical markers in 44 EA cases with 88 polyhydramnios and 88 nonpolyhydramnios controls. Both matched for GA with cases. Total proteins, alpha-fetoprotein (AFP), and digestive enzyme activities were assayed, including gamma-glutamyl transpeptidase (GGTP). We defined an EA index (AFP multiplied by GGTP). A significant difference (p < 0.0001) was observed for total protein, AFP, GGTP, and EA index between the EA group and each of the two control groups. No statistical difference was observed for any marker between the two most frequent EA subgroups (type I and type III) or between the two control groups. Using a cutoff of 3 for the EA index, 98% sensitivity and 100% specificity were observed for amniotic fluid prenatal diagnosis of EA, whatever the anatomical type. A large prospective series is required to confirm these results.
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Affiliation(s)
- Isabelle Czerkiewicz
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Université Paris Ile de France Ouest, Paris 75019, France
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42
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Ultrasound and MRI prenatal diagnosis of esophageal atresia: effect on management. J Pediatr Gastroenterol Nutr 2011; 52 Suppl 1:S9-11. [PMID: 21499050 DOI: 10.1097/mpg.0b013e3182125864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Hamrick SEG, Strickland MJ, Shapira SK, Autry A, Schendel D. Use of special education services among children with and without congenital gastrointestinal anomalies. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 115:421-432. [PMID: 20687825 DOI: 10.1352/1944-7558-115-5.421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our objective was to evaluate the relationship between congenital gastrointestinal anomalies requiring neonatal surgery and neurodevelopmental outcome. Among the children born in metropolitan Atlanta during 1982-2001 who survived to age 1 year (N = 762,824), we identified children with congenital gastrointestinal anomalies via linkage with the Metropolitan Atlanta Congenital Defects Program and children who received special education services via linkage with the Special Education Database of Metropolitan Atlanta. Several modest increases in special education service use were observed among children with isolated congenital gastrointestinal anomalies; no association was statistically significant. Among children with Hirschsprung disease, gastroschisis, esophageal atresia, intestinal malrotation, bowel atresia, or imperforate anus who had multiple anomalies, we observed statistically significant increases in special education service use.
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Affiliation(s)
- Shannon E G Hamrick
- Emory University School of Medicine, Division of Neonatology, Atlanta, GA 30322, USA.
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Seo J, Kim DY, Kim AR, Kim DY, Kim SC, Kim IK, Kim KS, Yoon CH, Pi SY. An 18-year experience of tracheoesophageal fistula and esophageal atresia. KOREAN JOURNAL OF PEDIATRICS 2010; 53:705-10. [PMID: 21189942 PMCID: PMC2994136 DOI: 10.3345/kjp.2010.53.6.705] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 09/08/2009] [Accepted: 09/22/2009] [Indexed: 12/19/2022]
Abstract
Purpose To determine the clinical manifestations and outcomes of patients with tracheoesophageal fistula (TEF) and esophageal atresia (EA) born at a single neonatal intensive care unit. Methods A retrospective analysis was conducted for 97 patients with confirmed TEF and EA who were admitted to the neonatal intensive care unit between 1990 and 2007. Results The rate of prenatal diagnosis was 12%. The average gestational age and birth weight were 37+2 weeks and 2.5±0.7 kg, respectively. Thirty-one infants were born prematurely (32%). Type C was the most common. The mean gap between the proximal and distal esophagus was 2 cm. Esophago-esophagostomy was performed in 72 patients at a mean age of 4 days after birth; gastrostomy or duodenostomy were performed in 8 patients. Forty patients exhibited vertebral, anorectal, cardiac, tracheoesophageal, renal, limb (VACTERL) association with at least 2 combined anomalies, and cardiac anomaly was the most common. The most common post-operative complications were esophageal stricture followed by gastroesophageal reflux. Balloon dilatation was performed for 1.3 times in 26 patients at a mean age of 3 months. The mortality and morbidity rates were 24% and 67%, respectively, and the most common cause of death was sepsis. The weight of approximately 40% patients was below the 10th percentile at 2 years of age. Conclusion Mortality and morbidity rates of patients with TEF and EA are high as compared to those of infants with other neonatal surgical diseases. Further efforts must be taken to reduce mortality and morbidity and improve growth retardation.
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Affiliation(s)
- Juhee Seo
- Department of Pediatrics, Ulsan University College of Medicine, Asan Medical Center, Children's Hospital, Seoul, Korea
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de Jong EM, de Haan MAM, Gischler SJ, Hop W, Cohen-Overbeek TE, Bax NMA, de Klein A, Tibboel D, Grijseels EWM. Pre- and postnatal diagnosis and outcome of fetuses and neonates with esophageal atresia and tracheoesophageal fistula. Prenat Diagn 2010; 30:274-9. [PMID: 20112230 DOI: 10.1002/pd.2466] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Clinical symptoms and ultrasound signs during pregnancy could suggest the presence of esophageal atresia (EA). However, most often EA is diagnosed postnatally. The aim of our study is to evaluate the course and outcome for prenatally and postnatally diagnosed EA. In addition, we studied the outcome of isolated versus nonisolated EA. METHODS In a retrospective data analysis, ultrasound characteristics, maternal and neonatal variables as well as clinical outcome were compared for fetuses/neonates with prenatal (n = 30) or postnatal (n = 49) diagnosis of EA. Clinical outcome in terms of morbidity and mortality of isolated EA was compared with that of EA complicated by chromosomal or structural anomalies. RESULTS Prenatally diagnosed children were born 2 weeks earlier than postnatally diagnosed children (36.4 weeks vs 38.2 weeks; P = 0.02). The former had higher mortality rates (30 vs 12%; P = 0.05) and more associated anomalies (80 vs 59%; P = 0.04). In both subsets, there was a high morbidity rate in the survivors (not significant). Nonisolated EA was associated with greater occurrence of polyhydramnios (53 vs 27%; P = 0.04) and higher mortality rate (28 vs 0%; P = 0.002). CONCLUSIONS Mortality was significantly higher in prenatally diagnosed infants and in infants with additional congenital anomalies. Isolated EA is associated with good outcome.
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Affiliation(s)
- E M de Jong
- Department of Pediatric Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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46
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Esophageal Morbidity and Function in Adults With Repaired Esophageal Atresia With Tracheoesophageal Fistula. Ann Surg 2010; 251:1167-73. [DOI: 10.1097/sla.0b013e3181c9b613] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sistonen SJ, Helenius I, Peltonen J, Sarna S, Rintala RJ, Pakarinen MP. Natural history of spinal anomalies and scoliosis associated with esophageal atresia. Pediatrics 2009; 124:e1198-204. [PMID: 19901003 DOI: 10.1542/peds.2008-3704] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Clinical characteristics of spinal deformities that commonly occur in patients with esophageal atresia (EA) are unclear. The objective of this study was to assess the incidence and natural history of spinal anomalies and scoliosis in patients with EA. METHODS A population-based cohort of 100 adults who had an operation for EA in our hospital were examined clinically and radiographically for spinal deformities. The results were compared with data obtained from normal population-based controls. RESULTS Vertebral anomalies were observed in 45 patients, predominating in the cervical spine in 38 patients. Any additional anomaly was the most significant risk factor (odds ratio [OR]: 27 [95% confidence interval (CI): 8-100]) for the occurrence of vertebral anomalies. Scoliosis of >10 degrees was observed in 56 patients, >20 degrees in 11 patients, and >45 degrees in 1 patient. The risk for scoliosis of >10 degrees was 13-fold (OR: 13 [95% CI: 8.3-21]), and the risk for scoliosis of >20 degrees was 38-fold (OR: 38 [95% CI: 14-106]) compared with those in the normal population. Thoracotomy-induced rib fusions (OR: 3.6 [95% CI: 0.7-19]) and other associated anomalies (OR: 2.1 [95% CI: 0.9-2.9]) were the strongest predictive factors for scoliosis. The general clinical course of spinal deformities was mild, and none of the patients had undergone spinal surgery. CONCLUSIONS The risk of scoliosis is 13-fold after repair of EA in relation to general population. Nearly half of the patients have vertebral anomalies predominating in the cervical spine. Most of these deformities were not diagnosed primarily or during growth. Spinal surgery is rarely indicated.
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Affiliation(s)
- Saara J Sistonen
- Section of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
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48
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Durkin EF, Shaaban A. Commonly encountered surgical problems in the fetus and neonate. Pediatr Clin North Am 2009; 56:647-69, Table of Contents. [PMID: 19501697 DOI: 10.1016/j.pcl.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neonatal surgical care requires a current understanding of pre- and postnatal intervention for a myriad of congenital anomalies. This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care.
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Affiliation(s)
- Emily F Durkin
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, H4/325 Clinical Science Center, Madison, WI 53798, USA
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Houben CH, Curry JI. Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula. Prenat Diagn 2008; 28:667-75. [PMID: 18302317 DOI: 10.1002/pd.1938] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasonographic features suggestive of esophageal atresia with or without tracheo-esophageal fistula (EA/TEF) are only in a small minority of fetuses with EA/TEF (<10%) identifiable on prenatal scans.The prenatal diagnosis of EA/TEF relies in principle, on two nonspecific signs: polyhydramnios and absent or small stomach bubble. Polyhydramnios is associated with a wide range of fetal abnormalities, but most commonly it pursues a benign course. Similarly the sonographic absence of a stomach bubble may point to a variety of fetal anomalies.The combination of polyhydramnios and absent stomach bubble in two small series offers a modest positive predictive value of 44 and 56% respectively. Prenatal scanning for EA/TEF identifies a larger proportion of fetuses with Edwards syndrome; there is also a higher proportion of isolated EA in comparison to postnatal studies.Current ultrasound technology does not allow for a definite diagnosis of EA/TEF and therefore, counseling of parents should be guarded.Postnatal diagnosis of EA is confirmed by the failure to pass a firm nasogastric tube into the stomach; on chest X-ray, the tube is seen curling in the upper esophageal pouch. Corrective surgery for EA/TEF is well established and survival rates of over 90% can be expected.
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Affiliation(s)
- C H Houben
- Department of Paediatric Surgery, Hospitals for Sick Children, Great Ormond Street, London WC1N 3JH, UK
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Li Y, Gordon J, Manley NR, Litingtung Y, Chiang C. Bmp4 is required for tracheal formation: a novel mouse model for tracheal agenesis. Dev Biol 2008; 322:145-55. [PMID: 18692041 DOI: 10.1016/j.ydbio.2008.07.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
Tracheal agenesis/atresia (TA) is a rare but fatal congenital disease in which the breathing tube fails to grow. The etiology of this serious condition remains largely unknown. We found that Bmp signaling is prominently present in the anterior foregut where the tracheal primordium originates and targeted ablation of Bmp4 (Bmp4(cko)) resulted in a loss-of-trachea phenotype that closely resembles the Floyd type II pathology, the most common form of TA in humans. In Bmp4(cko) embryos, tracheal specification was not affected; however, its outgrowth was severely impaired due to reduced epithelial and mesenchymal proliferation. In agreement, we also observed significant reduction in the expression of Cyclin D1, a key cell cycle regulator associated with cellular proliferation. However, the proliferative effect of Bmp signaling appears to be independent of Wnt signaling. Interestingly, we found significantly reduced expression of activated extracellular signal-regulated kinase (Erk) in the Bmp4(cko) ventral foregut, suggesting that Bmp signaling promotes Erk phosphorylation which has been associated with cellular proliferation. This study provides the first evidence linking Bmp signaling to tracheal formation by regulating the proliferative response of the anterior ventral foregut. Our finding sheds light on human tracheal malformations by providing a novel mouse model implicating Bmp signaling, non-canonical Erk activation and cellular proliferation.
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Affiliation(s)
- Yina Li
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, 4114 MRB3, Nashville, TN 37232, USA
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