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Pediatric Surgery International

Published in:

01-09-2017 | Original Article

Mortality and morbidity in oesophageal atresia

Authors: Robert T. Peters, Hany Ragab, Malachy O. Columb, James Bruce, Ralph J. MacKinnon, Ross J. Craigie

Published in: Pediatric Surgery International | Issue 9/2017

Abstract

Background

Several classification systems exist to predict mortality in oesophageal atresia, the most widely quoted of these being over 20 years old. No classification system exists to predict morbidity. We sought to test whether these classification systems remain relevant and to determine whether they can be useful to predict morbidity. In addition, we aimed to identify independent risk factors for predicting mortality and morbidity.

Methods

Neonates presenting with oesophageal atresia over a 20-year period (1990–2010) were retrospectively reviewed. Discriminative statistical analysis compared the performance of current classification systems. Stepwise logistic regression analysis of the influence of perioperative risk factors on mortality and duration of ventilatory support and intensive care unit stay were performed.

Results

All classification systems predicted mortality in this series of 248 neonates. Birth weight, cardiac anomalies and pre-operative pneumonia were independent risk factors for predicting mortality in oesophageal atresia. The Waterston classification is the most useful classification for predicting post-operative morbidity in terms of length of hospital stay and time spent ventilated.

Conclusion

Despite advances in the neonatal care of the very low birth weight infant and those with congenital cardiac disease, these conditions remain relevant in predicting mortality and morbidity in oesophageal atresia.

Haight C, Towsley H (1943) Congenital atresia of the esophagus with tracheoesophageal fistula: extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet 76:672–688

Wang B, Tashiro J, Allan BJ, Sola JE, Parikh PP, Hogan AR et al (2014) A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States. J Surg Res 190(2):604–612. doi:10.1016/j.jss.2014.04.033 CrossRefPubMed

Allin B, Knight M, Johnson P, Burge D, BAPS-CASS (2014) Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One 9(8):e106149. doi:10.1371/journal.pone.0106149 CrossRefPubMedPubMedCentral

Waterston DJ, Carter RE, Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1(7234):819–822CrossRefPubMed

Poenaru D, Laberge JM, Neilson IR, Guttman FM (1993) A new prognostic classification for esophageal atresia. Surgery 113(4):426–432PubMed

Spitz L, Kiely EM, Morecroft JA, Drake DP (1994) Oesophageal atresia: at-risk groups for the 1990s. J Pediatr Surg 29(6):723–725CrossRefPubMed

Spitz L (2006) Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 41(10):1635–1640. doi:10.1016/j.jpedsurg.2006.07.004 CrossRefPubMed

Lopez PJ, Keys C, Pierro A, Drake DP, Kiely EM, Curry JI et al (2006) Oesophageal atresia: improved outcome in high-risk groups? J Pediatr Surg 41(2):331–334. doi:10.1016/j.jpedsurg.2005.11.009 CrossRefPubMed

Murphy SL, Kochanek KD, Xu J, Heron M (2015) Deaths: final data for 2012. Natl Vital Stat Rep 63(9):1–118

10.

Gardner P, Hudson BL (1996) Advance report of final mortality statistics, 1993. Monthly vital statistics report. Hyattsville Md Natl Cent Health Stat 44(7):s1–s83

11.

Khairy P, Ionescu-Ittu R, Mackie AS, Abrahamowicz M, Pilote L, Marelli AJ (2010) Changing mortality in congenital heart disease. J Am Coll Cardiol 56(14):1149–1157. doi:10.1016/j.jacc.2010.03.085 CrossRefPubMed

12.

Sulkowski JP, Cooper JN, Lopez JJ, Jadcherla Y, Cuenot A, Mattei P et al (2014) Morbidity and mortality in patients with esophageal atresia. Surgery 156(2):483–491. doi:10.1016/j.surg.2014.03.016 CrossRefPubMedPubMedCentral

13.

Okamoto T, Takamizawa S, Arai H, Bitoh Y, Nakao M, Yokoi A et al (2009) Esophageal atresia: prognostic classification revisited. Surgery 145(6):675–681. doi:10.1016/j.surg.2009.01.017 CrossRefPubMed

14.

Deurloo JA, de Vos R, Ekkelkamp S, Heij HA, Aronson DC (2004) Prognostic factors for mortality of oesophageal atresia patients: waterston revived. Eur J Pediatr 163(10):624–625. doi:10.1007/s00431-004-1505-y CrossRefPubMed

15.

Driver CP, Shankar KR, Jones MO, Lamont GA, Turnock RR, Lloyd DA et al (2001) Phenotypic presentation and outcome of esophageal atresia in the era of the Spitz classification. J Pediatr Surg 36(9):1419–1421. doi:10.1053/jpsu.2001.26389 CrossRefPubMed

16.

Sinha CK, Haider N, Marri RR, Rajimwale A, Fisher R, Nour S (2007) Modified prognostic criteria for oesophageal atresia and tracheo-oesophageal fistula. Eur J Pediatr Surg 17(3):153–157. doi:10.1055/s-2007-965394 CrossRefPubMed

17.

Teich S, Barton DP, Ginn-Pease ME, King DR (1997) Prognostic classification for esophageal atresia and tracheoesophageal fistula: Waterston versus Montreal. J Pediatr Surg 32(7):1075–1079 (discussion 1079–1080) CrossRefPubMed

18.

Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL (1999) Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 34(1):70–73 (discussion 74) CrossRefPubMed

19.

Rokitansky AM, Kolankaya VA, Seidl S, Mayr J, Bichler B, Schreiner W et al (1993) Recent evaluation of prognostic risk factors in esophageal atresia–a multicenter review of 223 cases. Eur J Pediatr Surg 3(4):196–201CrossRefPubMed

20.

Lal DR, Gadepalli SK, Downard CD, Ostlie DJ, Minneci PC, Swedler RM et al (2016) Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. doi:10.1016/j.jpedsurg.2016.11.046 (Epub ahead of print)

Title: Mortality and morbidity in oesophageal atresia
Authors: Robert T. Peters
Hany Ragab
Malachy O. Columb
James Bruce
Ralph J. MacKinnon
Ross J. Craigie
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 9/2017
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-017-4124-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mortality and morbidity in oesophageal atresia

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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