This literature review is devoted to the problem of predicting in-hospital mortality in newborns with esophageal atresia (EA). According to epidemiological study data, in developed countries, the mortality rate in newborns with EA ranges from 9% to 11% over the past 20 years. Three classifications were developed, Waterston 1962, Montreal 1993, and Spitz 1994, to assess the prognostic significance of risk factors. They considered birth weight, the presence of concomitant congenital malformations and pneumonia, and the need for mechanical ventilation. The choice of a model for predicting outcomes depends on the level of health care and other factors, such as prematurity, low birth weight, late diagnosis, and infectious complications. These factors have a greater impact on patient survival in developing countries than in developed ones, where insurmountable risk factors come out on top: combined congenital malformations and very low birth weight. Also, the magnitude of diastasis between segments of the esophagus creates difficulties in choosing surgical tactics and managing such patients in the postoperative period. In addition, the management of such patients in the intensive care unit, both preoperatively and postoperatively, has a significant impact on the outcome. The literature review underlined "pain points" in the treatment of newborns with EA in regions with different levels of medical care, the consideration of which will allow the achievement of better results.
Проведен анализ интенсивной, респираторной и нутритивной поддержки. Комплексный подход позволил улучшить качество и уровень специализированной помощи детям с АП. Ключевые слова: атрезия пищевода, хирургия новорожденных, интенсивная терапия новорожденныхEsophageal atresia (EA) is the most common congenital abnormality of the oesophagus. The survival rate of patients with this defect varies from 86.9 % to 95 %. Seventy eight newborns with EA were treated from 2011 to 2017; 58.9 % were male children, 48.7 % were premature, 51.3 % had associated anomalies. Mortality was 10.25 % and was associated with severe prematurity and sepsis. Direct esophagoesophagoanastomosis was formed in 60 (76.9 %) children, cervical esophagostomy with gastrostomy -in 17 (21.8 %) children. Postoperative morbidity occurred in 76,9 % of the population, including 4 (6.7 %) cases with anastomotic leak and anastomotic stricture in 43 (71.7 %), in those patients, who had anastomosis; recurrent fistula in 2 (2.6 %), pneumonia in 22 (28.2 %) and late-onset sepsis in 13 (16.7 %). Our study also highlights issues related to respiratory support, nutritional support and antibiotic therapy. Integrated approach has improved the quality and level of specialized care for children with EA.
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