A scoring system to predict mortality in infants with esophageal atresia

Abstract

Esophageal atresia (EA) is a rare anomaly that mandates surgical intervention. Patients with EA often have complicated medical courses due to both esophageal anomalies and related comorbidities. Although several prognostic classification systems have been developed to decrease the mortality rate in EA, most systems focus only on the influence of the major anomaly, and external risk factors that could be influenced by the neonatal caregivers to a certain extent are not included. The aim of this study was to investigate the risk factors for in-hospital mortality in neonates with EA and develop a scoring model to predict mortality.In total, 198 infants with EA who were treated with surgical intervention at the Children's Hospital of Chongqing Medical University between March 2004 and June 2016 were included. The demographic information, clinical manifestations, laboratory testing, and outcomes during hospitalization were analyzed retrospectively. A predictive scoring model was developed according to the regression coefficients of the risk factors.The mortality rate was 18.1% (36/198). In the univariate analysis, higher incidences of prematurity, low birth weight, long gap, anastomotic leak, respiratory failure, postoperative sepsis, respiratory distress syndrome, pneumothorax, and septic shock were found in the nonsurvivor group than in the survivor group (P < .05). In the logistic regression analysis, anastomotic leak (OR: 10.75, 95% CI: 3.113–37.128), respiratory failure (OR: 4.104, 95% CI: 2.292–7.355), postoperative sepsis (OR: 3.564, 95% CI: 1.516–8.375), and low birth weight (OR: 8.379, 95% CI: 3.357–20.917) were associated with a high mortality rate. A scoring model for predicting death was developed with a sensitivity of 0.861, a specificity of 0.827, a positive predictive value of 0.524, and a negative predictive value of 0.963 at a cutoff of 2 points. The area under the receiver-operating characteristic curve of the score was 0.905 (95% CI, 0.863–0.948, P = .000) for death from EA. The mortality rate increased rapidly as the scores increased, and all patients with scores ≥5 died.Anastomotic leak, respiratory failure, postoperative sepsis, and low birth weight are independent risk factors for mortality in EA. Infants with a predictive score of 5 had a high risk of death.

Gastrointestinal disorders in Down syndrome

“…The prevalence of esophageal atresia in general population is 0.09% or an average of 1 in every 4,099 births worldwide (Johnson, Lillis, Delany, Hayes, & Dack, ; Nassar et al, ). Esophageal atresia is associated to a mortality rate of 18.1% in the first weeks of life, operated or not (Li, Jiang, Wang, Yu, & Li, ). The lower incidence in our patients might be due to median age at the first visit (2 months).…”

Esophageal atresia: predicting outcomes and decreasing mortality

“…Среди факторов риска немаловажным является сопутствующая соматическая патология: пневмония (как аспирационная, так и инфекционного генеза), респираторный дистресс-синдром, наличие или отсутствие генерализованной бактериальной инфекции на дооперационном этапе [3,4]. В Китае за период с марта 2004 г. по июнь 2016 г. проведено исследование, целью которого было выявление влияния на внутрибольничную летальность таких факторов, как сепсис и РДС [35]. Критериями исключения стали случаи летального исхода до операции, пациенты с врожденными пороками почек и сердца.…”

“…Итогом проведенного исследования стало выделение групп риска в зависимости от суммы полученных баллов (табл. 3) [35].…”

“…Другая работа, включившая данные о пациентах с февраля 2004 г. по май 2006 г., в качестве основного критерия благополучного исхода оценивали выписку и возможность перорального кормления [39]. В отличие от работы китайских авторов [35], в настоящем исследовании пороки развития сердца и почек не стали критериями исключения, что, вероятно, обусловило высокую летальность (в 1,6 раза выше). Среди 127 новорожденных сочетанные пороки развития, в том числе ассоциация VACTERL, диагностированы у 41 %.…”

Die Ösophagusatresie – von der Herausforderung in der Pränatalmedizin bis zur chirurgischen Versorgung

“…Als ungünstige Prognosefaktoren gelten ein niedriges Geburtsgewicht ( < 1500 g), eine Operation innerhalb der ersten 24 Lebensstunden, eine kleine Gestationswoche ( < 28) und ein vorliegender Herzfehler [75,80]. Es hat sich gezeigt, dass assoziierte Malformationen ein starker Prädiktor für das postnatale Versterben ist [19/69 vs. 3 [82].…”