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Tanny SPT, King SK, Comella A, Hawley A, Brooks JA, Hunt RW, Jones B, Teague WJ. Selective approach to preoperative echocardiography in esophageal atresia. Pediatr Surg Int 2021; 37:503-509. [PMID: 33388963 DOI: 10.1007/s00383-020-04795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography. METHODS We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%. CONCLUSION Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.
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Affiliation(s)
- Sharman P Tan Tanny
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Assia Comella
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Alisa Hawley
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Jo-Anne Brooks
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Rod W Hunt
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia.,Clinical Sciences, Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Bryn Jones
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
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