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Zouari M, Ameur HB, Krichen E, Saad NB, Dhaou MB, Mhiri R. Risk factors for adverse outcomes following surgical repair of esophageal atresia. A retrospective cohort study. Dis Esophagus 2023; 36:doac070. [PMID: 36214334 DOI: 10.1093/dote/doac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Esophageal atresia (EA) is a life-threatening congenital malformation of the esophagus. Despite considerable recent advances in perinatal resuscitation and neonatal care, EA remains an important cause of mortality and morbidity, especially in low-income countries. The aim of this study was to assess risk factors for adverse outcomes following surgical repair of EA at a single center in Tunisia. We performed a retrospective analysis using medical records of neonates with surgical management of EA at our institution from 1 January 2007 to 31 December 2021. In total, 88 neonates were included with a mortality rate of 25%. There were 29 girls and 59 boys. The diagnosis of EA was suspected prenatally in 19 patients. The most common associated anomalies were congenital heart diseases. Prematurity, low birth weight, outborn birth, age at admission >12 hours, congenital heart disease, postoperative sepsis, and anastomotic leak were risk factors for mortality following surgical repair of EA. Anastomotic tension was the only factor associated with short-term complications and the occurrence of short-term complications was predictive of mid-term complications. This study provides physicians and families with contemporary information regarding risk factors for adverse outcomes following surgical repair of EA. Thus, any effort to reduce these risk factors would be critical to improving patient outcomes and reducing cost. Future multi-institutional studies are needed to identify, investigate, and establish best practices and clinical care guidelines for neonates with EA.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nesrine Ben Saad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Dey S, Raman VS, Agarwala S, Narwar P. Assessing the Feasibility of Predicting Intermediate Outcomes of Esophageal Atresia Using Okamoto Classification: A Prospective Study. J Indian Assoc Pediatr Surg 2023; 28:144-148. [PMID: 37197244 PMCID: PMC10185033 DOI: 10.4103/jiaps.jiaps_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 05/19/2023] Open
Abstract
Purpose Several risk classifications based on various preoperative factors have been proposed to prognosticate the immediate survival of children operated for esophageal atresia. A major drawback of these classifications is that they only focus on immediate survival while ignoring the long-term morbidity and mortality in these children. Our study aims to bridge this gap in knowledge by studying the impact of one such classification (Okamoto's classification) on mortality and morbidity during a period of 1 year after discharge from the hospital in operated cases of esophageal atresia. Materials and Methods After institutes ethical clearance, 106 children operated for esophageal atresia-tracheoesophageal fistula between 2012 and 2015 were studied prospectively for a period of 1 year after their discharge. The children were graded as per Okamoto classification. The primary objective was to determine the efficacy of this classification in predicting the survival rates in infancy and the secondary objective was to compare the complication rates in these children based on the classification. Results Sixty-nine children met the inclusion criteria. There were 40, 15, 10, and 4 children in Okamoto Classes I, II, III, and IV, respectively. Twenty-one patients (30%) died during the follow-up period with the maximum number of deaths occurring in Okamoto Class IV (75%) and the minimum in Okamoto Class I (17.5%) (P = 0.003). There was a significant correlation between the Okamoto classes with the incidence of poor weight gain (P = 0.001), lower respiratory tract infection (P = 0.007), and failure to thrive (P = 0.01) higher in Okamoto IV and III as compared to I and II. Conclusion Okamoto prognostic classification during the initial hospitalization is relevant even at 1 year follow-up with increased mortality and morbidity in Okamoto Class IV as compared to Class I.
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Affiliation(s)
- Santosh Dey
- Department of Pediatric Surgery, Army Hospital (Research and Referral), New Delhi, India
| | - V. Shankar Raman
- Department of Pediatric Surgery, Command Hospital (SC), Pune, Maharashtra, India
| | | | - Parul Narwar
- Department of Psychiatry, GMC, Chandigarh, India
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Zvizdic Z, Becirovic N, Milisic E, Jonuzi A, Terzic S, Vranic S. Epidemiologic and clinical characteristics of selected congenital anomalies at the largest Bosnian pediatric surgery tertiary center. Medicine (Baltimore) 2022; 101:e32148. [PMID: 36482591 PMCID: PMC9726290 DOI: 10.1097/md.0000000000032148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Congenital anomalies (CA) are any abnormality present at birth, either structural or functional, that may potentially affect an infant's health, development, and/or survival. There is a paucity of studies on clinical characteristics and outcomes of CA in Bosnia and Herzegovina, mainly due to the lack of a nationwide congenital malformations monitoring system. A 5-year hospital-based study was conducted to determine the prevalence at birth and clinical characteristics of selected major CA in Sarajevo Canton, Bosnia and Herzegovina. Ninety-one CA were observed from 2012 to 2016 (the overall prevalence was 39.6 cases/10,000 live births). The mean age of neonates at diagnosis was 3 days. The gastrointestinal tract was the most commonly affected system (76.9%), with esophageal atresia (EA) being the most frequent (17.6% of all CA). Major CA were more prevalent among preterm infants than term infants (P = .001), particularly in males (61.5% vs. 38.5%; P = .028; M:F ratio was 1.59). Multiple CA were seen in 37.4% of neonates. The overall mortality rate of neonates was 11%, and the median length of hospital stay was 19.8 days. Our study revealed the distribution and clinical patterns of common major CA in the largest tertiary care facility in Bosnia and Herzegovina. It also confirmed a relatively high mortality rate, which requires further efforts to improve the quality of neonatal care in the country.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Naida Becirovic
- Department of Surgery, General Hospital “Prim. Dr Abdulah Nakas,” Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sabina Terzic
- Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- * Correspondence: Semir Vranic, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar (e-mail: )
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Cho JY, Chang MY, Gang MH, Lee YW, Park JB, Kim JY, Kim HJ. Postoperative Complications of Esophageal Atresia and Role of Endoscopic Balloon Dilatation in Anastomotic Strictures. Pediatr Gastroenterol Hepatol Nutr 2022; 25:453-460. [PMID: 36451690 PMCID: PMC9679305 DOI: 10.5223/pghn.2022.25.6.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 09/18/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. METHODS We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients' baseline characteristics, associated anomalies, and postoperative complications were reviewed. RESULTS Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2-15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2-7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. CONCLUSION Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.
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Affiliation(s)
- Jin Young Cho
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mea-Young Chang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mi Hyeon Gang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong Wook Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jun Beom Park
- Division of Pediatric Surgery, Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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Keefe G, Culbreath K, Edwards EM, Morrow KA, Soll RF, Modi BP, Horbar JD, Jaksic T. Current outcomes of infants with esophageal atresia and tracheoesophageal fistula: A multicenter analysis. J Pediatr Surg 2022; 57:970-974. [PMID: 35300859 DOI: 10.1016/j.jpedsurg.2022.01.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to quantify mortality rates and hospital lengths of stay (LOS) in neonates with esophageal atresia and tracheoesophageal fistula (EA/TEF), and to characterize the effects of birth weight (BW) and associated congenital anomalies upon these. METHODS Data regarding patients with EA/TEF were prospectively collected (2013-2019) at 298 North American centers. The primary outcome was mortality and secondary outcome was LOS. Risk factors affecting mortality and LOS were assessed. RESULTS EA/TEF was diagnosed in 3290 infants with a median BW of 2476 g (IQR 1897,2970). In-hospital mortality was 12.7%. Mortality was inversely correlated with BW. After adjustment, the risk of mortality decreased by approximately 11% with every 100 g increase in BW. A significant congenital anomaly other than EA/TEF was diagnosed in 37.9% of patients. Risk of mortality increased in patients with associated congenital anomalies, most notably in those with a severe cardiac anomaly. Lower BW was associated with an increased mean LOS among survivors. Similar to mortality risk, additional anomalies were associated with prolonged LOS. CONCLUSIONS This study demonstrates an in-hospital mortality of over 10%. Both increased mortality and prolonged LOS are highly associated with lower birth weight and the presence of concomitant congenital anomalies.
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Affiliation(s)
- Gregory Keefe
- Boston Children's Hospital, Department of Surgery, Boston, MA, United States of America
| | - Katherine Culbreath
- Boston Children's Hospital, Department of Surgery, Boston, MA, United States of America
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, United States of America
| | - Kate A Morrow
- Vermont Oxford Network, Burlington, VT, United States of America
| | - Roger F Soll
- Vermont Oxford Network, Burlington, VT, United States of America
| | - Biren P Modi
- Boston Children's Hospital, Department of Surgery, Boston, MA, United States of America
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, United States of America
| | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery, Boston, MA, United States of America.
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Evanovich DM, Wang JT, Zendejas B, Jennings RW, Bajic D. From the Ground Up: Esophageal Atresia Types, Disease Severity Stratification and Survival Rates at a Single Institution. Front Surg 2022; 9:799052. [PMID: 35356503 PMCID: PMC8959439 DOI: 10.3389/fsurg.2022.799052] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Esophageal atresia (EA), although a rare congenital anomaly, represents one of the most common gastrointestinal birth defects. There is a gap in our knowledge regarding the impact of perioperative critical care in infants born with EA. This study addresses EA types, disease severity stratification, and mortality in a retrospective cohort at a single institution. Institutional Review Board approved our retrospective cross-sectional study of term-born (n = 53) and premature infants (28–37 weeks of gestation; n = 31) that underwent primary surgical repair of EA at a single institution from 2009–2020. Demographic and clinical data were obtained from the electronic medical record, Powerchart (Cerner, London, UK). Patients were categorized by (i) sex, (ii) gestational age at birth, (iii) types of EA (in relation to respiratory tract anomalies), (iv) co-occurring congenital anomalies, (v) severity of disease (viz. American Society of Anesthesiologists (ASA) and Pediatric Risk Assessment (PRAm) scores), (vi) type of surgical repair for EA (primary anastomosis vs. Foker process), and (vii) survival rate classification using Spitz and Waterston scores. Data were presented as numerical sums and percentages. The frequency of anatomical types of EA in our cohort parallels that of the literature: 9.5% (8/84) type A, 9.5% (8/84) type B, 80% (67/84) type C, and 1% (1/84) type D. Long-gap EA accounts for 88% (7/8) type A, 75% (6/8) type B, and 13% (9/67) type C in the cohort studied. Our novel results show a nearly equal distribution of sex per each EA type, and gestational age (term-born vs. premature) by anatomical EA type. PRAm scoring showed a wider range of disease severity (3–9) than ASA scores (III and IV). The survival rate in our EA cohort dramatically increased in comparison to the literature in previous decades. This retrospective analysis at a single institution shows incidence of EA per sex and gestational status for anatomical types (EA type A-D) and by surgical approach (primary anastomosis vs. Foker process for short-gap vs. long-gap EA, respectively). Despite its wider range, PRAm score was not more useful in predicting disease severity in comparison to ASA score. Increased survival rates over the last decade suggest a potential need to assess unique operative and perioperative risks in this unique population of patients. Presented findings also represent a foundation for future clinical studies of outcomes in infants born with EA.
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Affiliation(s)
- Devon Michael Evanovich
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Tufts School of Medicine, Tufts University, Boston, MA, United States
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Benjamin Zendejas
- Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, MA, United States
| | - Russell William Jennings
- Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
- *Correspondence: Dusica Bajic
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Deguchi K, Tazuke Y, Matsuura R, Nomura M, Yamanaka H, Soh H, Yoneda A. Factors Associated With Adverse Outcomes Following Duodenal Atresia Surgery in Neonates: A Retrospective Study. Cureus 2022; 14:e22349. [PMID: 35371797 PMCID: PMC8936229 DOI: 10.7759/cureus.22349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives There is limited evidence on the infants' postoperative complications who have undergone surgical repair of duodenal atresia and stenosis. This study aimed to identify the factors associated with poor surgical outcomes after the initial repair. Methods We retrospectively reviewed the data of 82 patients who underwent surgery for duodenal atresia and stenosis between January 1994 and December 2013 at our institution. Gestational age, birth weight, fetal growth, and other associated anomalies were recorded. Multivariate regression analyses were used to identify the factors associated with surgical outcomes, including postoperative complications and time to full oral intake. Results The median gestational age was 37.6 weeks, with 30 (37%) preterm (<37 weeks) and 11 (13%) early preterm (<34 weeks) infants. The median birth weight was 2531 g, with 27 (33%) patients < 2000 g and 10 (12%) patients < 1500 g. Postoperative surgical complications were identified in 18 (22%) cases, of which 12 (15%) required additional operations. Multivariate regression analysis revealed that a combination of very low birth weight (<1500 g) and early preterm was significantly associated with both surgical and non-surgical postoperative complications (p = 0.0028 and 0.021, respectively) and a prolonged time to full oral intake postoperatively (p = 0.013). Conclusion Very low birth weight and early preterm were significantly associated with postoperative complications and a prolonged time to full oral intake.
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Narsat MA, Kılıç ŞS, Özden Ö, Alkan M, Tuncer R, İskit HS. Can 18-years of data from a tertiary referral center help to identify risk factors in esophageal atresia? Pediatr Int 2022; 64:e15190. [PMID: 35522674 DOI: 10.1111/ped.15190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Esophageal atresia is a complex esophageal malformation with an incidence of 1 in 3,500-4,000 live births, and it usually occurs together with anomalies in other systems or chromosomes. This study aimed to investigate the short-term and long-term results of cases of esophageal atresia retrospectively in our institution and to analyze the factors affecting the outcome. METHODS Charts of the patients managed for esophageal atresia in our tertiary pediatric surgery department were investigated retrospectively. Statistical analysis was performed to determine the risk factors for morbidity and mortality. RESULTS One hundred and thirteen (95.8%) of 118 cases underwent a single-stage or staged esophagoesophagostomy procedure. In only five of the 40 patients with a long gap between the two atretic ends was an esophageal replacement procedure required. The most common early and late complications were anastomotic stenosis (41.6%) and gastroesophageal reflux (44.9%). In logistic regression analysis, the birthweight (OR [95% CI] = 0.998 [0.997, 0.999], P = 0.001) and preoperative inotrope requirement (OR [95% CI] = 13.8 [3.6-53.3], P < 0.001) were the two risk factors in the mortality prediction model obtained by multivariate analysis. The gap length between the two atretic ends (OR [95% CI] = 1.436 [1.010, 2.041], P = 0.044) and the number of sutures for anastomosis (OR [95% CI] = 1.313 [1.042, 1.656], P = 0.021) were the two risk factors in the gastroesophageal reflux prediction model obtained by multivariate analysis. CONCLUSIONS Our study's early and late complication rates were like those found in other studies. Identifying risk factors would be beneficial and might help reduce the severity of potential complications in esophageal atresia patients. Prospective studies on large patient series would help develop registry-based, standardized management protocols.
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Affiliation(s)
- Mehmet Ali Narsat
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey.,Department of Pediatric Surgery, Kastamonu Training And Research Hospital, Kastamonu, Turkey
| | - Şeref Selçuk Kılıç
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Önder Özden
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Murat Alkan
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Recep Tuncer
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hilmi Serdar İskit
- Department of Pediatric Surgery, Faculty of Medicine, Çukurova University, Adana, Turkey
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Akpa O, Sarfo FS, Owolabi M, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Ogbole G, Tiwari HK, Jenkins C, Fakunle AG, Olowookere S, Uvere EO, Akinyemi J, Arulogun O, Akpalu J, Tito-Ilori MM, Asowata OJ, Ibinaiye P, Akisanya C, Oyinloye OI, Appiah L, Sunmonu T, Olowoyo P, Agunloye AM, Adeoye AM, Yaria J, Lackland DT, Arnett D, Laryea RY, Adigun TO, Okekunle AP, Calys-Tagoe B, Ogah OS, Ogunronbi M, Obiabo OY, Isah SY, Dambatta HA, Tagge R, Ogenyi O, Fawale B, Melikam CL, Onasanya A, Adeniyi S, Akinyemi R, Ovbiagele B. A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study. J Stroke Cerebrovasc Dis 2021; 30:106003. [PMID: 34332227 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES To develop Afrocentric risk-scoring models for stroke occurrence. MATERIALS AND METHODS We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. RESULTS For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%). CONCLUSIONS The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.
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Affiliation(s)
- Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, and Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | | | | | | | | | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | | | - Josephine Akpalu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Olalekan I Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Atinuke M Agunloye
- College of Medicine, University of Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | - Abiodun M Adeoye
- College of Medicine, University of Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | | | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | - Ruth Y Laryea
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, and Blossom Specialist Medical Center, Ibadan, Nigeria
| | | | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | | | | | - Olugbo Y Obiabo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Suleiman Y Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Raelle Tagge
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | | | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, and Blossom Specialist Medical Center, Ibadan, Nigeria; Federal Medical Centre, Abeokuta, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
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Folaranmi SE, Jawaid WB, Gavin L, Jones MO, Losty PD. Influence of birth weight on primary surgical management of newborns with esophageal atresia. J Pediatr Surg 2021; 56:929-932. [PMID: 33276972 DOI: 10.1016/j.jpedsurg.2020.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND To determine if birth-weight (BW) influences primary surgical management of newborns undergoing operation for esophageal atresia and tracheo-esophageal fistula (EA-TEF). METHODS Newborns undergoing repair of esophageal atresia at a single specialist centre between 1999 and 2017 were categorised into three groups based on BW; Group A < 1.5 kg, Group B <2.5 kg and Group C >2.5 kg. Outcome data analysed were (i) technical ability of the surgeon to perform primary esophageal anastomosis, (ii) anastomotic leak, (iii) anastomotic stricture, (iv) esophageal replacement, (v) need for other procedures notably fundoplication, aortopexy, tracheostomy and (vi) mortality. Statistical analysis was performed using a two-tailed Fisher's exact test and logistic regression. RESULTS 198 patients underwent surgery for EA-TEF during the study period, Group A (n = 13), Group B (n = 73) and Group C (n = 112). Inability to perform a primary anastomosis was significantly higher in Group A vs Group B (p = 0.003) and Group C (p = 0.004). Birthweight was a significant variable in the ability to perform a primary esophageal anastomosis (OR 1.009, p = 0.004). Mortality rate was significantly higher in Group A vs Group C (P = 0.0158). CONCLUSIONS Very low birth weight infants are less likely to achieve a definitive primary anastomosis during emergent repair of esophageal atresia, and have a higher mortality.
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Affiliation(s)
- Semiu E Folaranmi
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom
| | - Wajid B Jawaid
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom
| | - Luke Gavin
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom
| | - Matthew O Jones
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool L14 5AB, United Kingdom; Institute Of Translational Medicine & Child Health, University of Liverpool, Liverpool L69 3BX, United Kingdom.
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Maharjan A, Sharma AK, Kansakar P, K C S, Singh Y. Congenital Tracheoesophageal Fistula in Very Low Birth Weight Preterm Neonate with an Oligohydramnios as a Rare Presentation: A Case Report. JNMA J Nepal Med Assoc 2020; 58:1075-1079. [PMID: 34506396 PMCID: PMC8028519 DOI: 10.31729/jnma.5207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
Abstract
Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before caesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months age.
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Affiliation(s)
- Anu Maharjan
- Department of Surgery, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | | | - Prerana Kansakar
- Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Samyukta K C
- Department of Surgery, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
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Tan Tanny SP, Fearon E, Hawley A, Brooks JA, Comella A, Hutson JM, Teague WJ, Pellicano A, King SK. Predictors of Mortality after Primary Discharge from Hospital in Patients with Esophageal Atresia. J Pediatr 2020; 219:70-75. [PMID: 31952847 DOI: 10.1016/j.jpeds.2019.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe esophageal atresia mortality rates and their associations in our cohort. STUDY DESIGN Patients with esophageal atresia, managed at The Royal Children's Hospital, Melbourne (1980-2018), who subsequently died, were retrospectively identified from the prospective Nate Myers Oesophageal Atresia database. Data collected included patient and maternal demographics, vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, renal anomalies, and limb defects (VACTERL) associations, mortality risk factors, and preoperative, operative, and postoperative findings. Mortality before discharge was defined as death during the initial admission. RESULTS A total of 88 of the 650 patients (13.5%) died during the study period; mortality before discharge occurred in 66 of the 88 (75.0%); mortality after discharge occurred in 22 of the 88 (25.0%). Common causes of mortality before discharge were palliation for respiratory anomalies (15/66 [22.7%]), associated syndromes (11/66 [16.7%]), and neurologic anomalies (10/66 [15.2%]). The most common syndrome leading to palliation was trisomy 18 (7/66 [10.6%]). Causes of mortality after discharge had available documentation for 17 of 22 patients (77.3%). Common causes were respiratory compromise (6/17 [35.3%]), sudden unexplained deaths (6/17 [35.3%]), and Fanconi anemia (2/17 [11.8%]). Of the patients discharged from hospital, 22 of 584 (3.8%) subsequently died. There was no statistical difference in VACTERL association between mortality before discharge (31/61 [50.8%]) and mortality after discharge (11/20 [55.0%]), nor in incidence of twins between mortality before discharge (8/56 [14.3%]) and mortality after discharge (2/18 [11.1%]). CONCLUSIONS We identified predictors of mortality in patients with esophageal atresia in a large prospective cohort. Parents of children with esophageal atresia must be counselled appropriately as to the likelihood of death after discharge from hospital.
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Affiliation(s)
- Sharman P Tan Tanny
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Edward Fearon
- F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Hawley
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jo-Anne Brooks
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Assia Comella
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Medicine, Monash University, Clayton, Victoria, Australia
| | - John M Hutson
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Warwick J Teague
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Anastasia Pellicano
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
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