Delayed diagnosis: An important prognostic factor for oesophageal atresia in developing countries

Karakuş, Süleyman Cüneyt; Özokutan, Bülent Hayrı; Bakal, Ünal; Ceylan, Hasan Hüseyin; Saraç, Mehmet; Kül, Seval; Kazez, Ahmet

doi:10.1111/jpc.13354

Cited by 7 publications

(3 citation statements)

References 18 publications

(35 reference statements)

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“…This could hurt the survival of the EA neonates in the country, which was supported by the study conducted in Turkey and Tunisia. 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia

Moges¹,

Sebsbie²,

Adimasu³

et al. 2022

JMDH

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Background Esophageal atresia is an upper gastrointestinal tract developmental abnormality in which the upper and lower esophagus do not connect. Esophageal atresia has a higher incidence of death in sub-Saharan Africa, ranging from 30% to 80%. In Ethiopia, infants with esophageal atresia had a higher mortality rate. The assessment of time to death and predictors of esophageal atresia can help to reduce newborn mortality. Objective This study was aimed to investigate the time to death and predictors of neonates with esophageal atresia admitted to Tikur Anbessa Specialized Hospital, Ethiopia. Methods An institutional-based retrospective follow-up study was conducted among 225 neonates diagnosed with esophageal atresia. The median survival time, Kaplan–Meier failure estimation curve, and Log rank test were computed. Bivariable and multivariable Cox regression hazards models were fitted to identify the predictors of time to death. Hazard ratio with a 95% confidence interval was calculated and p-values <0.05 were considered statistically significant. Results In the study, the incidence density rate of neonates diagnosed with esophageal atresia was 5.5 (95% CI, 4.7–6.4) per 100-neonates day. The median time to death was 11 days (95% confidence interval (CI), 8.92–13.08). Birth weight <2500 g (adjusted hazard ratio (AHR)=1.49, 95% CI, 1.02 −2.21), having sepsis (AHR=1.67,95% CI, 1.15–2.44), being malnourished (AHR = 1.61, 95% CI, 1.03 −2.58), esophageal atretic neonates without surgery (AHR = 3.72, 95% CI, 1.34–10.38), diagnosis time at >48 hours of admission (AHR = 1.48, 95% CI, 1.01–2.15) and being dehydrated (AHR = 2.38, 95% CI, 1.63–3.46) were significant predictors of time to death among esophageal atretic neonates. Conclusion The findings in this study highlighted the necessity of early diagnosis, proper comorbidity treatment, and timely surgical intervention to reduce infant deaths due to esophageal atresia.

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“…This could hurt the survival of the EA neonates in the country, which was supported by the study conducted in Turkey and Tunisia. 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia

Moges¹,

Sebsbie²,

Adimasu³

et al. 2022

JMDH

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“…Delayed diagnosis of EA has been shown to be an independent negative prognostic factor in LMIC countries [4]. Infants presenting late are at a higher risk of developing aspiration pneumonia [5,6].…”

Section: Challenges In the Developing World For Tef Repairmentioning

confidence: 99%

Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?

et al. 2020

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Purpose Tracheoesophageal fistula (TEF) is a bellwether for a country's ability to care for sick newborns. We aim to review the existing literature from low-and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes. Methods A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies. Results While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management. Conclusion Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.

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“…This improvement is attributed to advances in neonatal anaesthesia, well-established neonatal intensive care units (NICU), availability of total parental nutrition (TPN) and refined surgical skills [1,[5][6][7][8]. Conversely, the surgical outcome of oesophageal atresia in developing countries still remains very poor due to lack of the aforementioned facilities, in addition to late presentation [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Oesophageal Atresia: Drowning a Child in His/Her Own Saliva

Osei-Nketiah¹,

Appeadu-Mensah²

2019

Pediatric Surgery, Flowcharts and Clinical Algorithms

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Oesophageal atresia (OA) is a congenital anomaly characterised by absence or loss of a segment of the oesophagus. This commonly affects the thoracic portion of the oesophagus, leaving upper and lower oesophageal segments. Loss of the oesophageal luminal continuity leads to impaired in utero swallowing of amniotic fluid as well as postnatal swallowing of saliva and food. Besides the loss of oesophageal continuity, most of the patients tend to have a connection between the trachea and the lower oesophageal segment and a few between the trachea and the upper oesophageal segment, a condition called tracheo-oesophageal fistula (TOF). In view of these, the main principles guiding the definitive surgical management of OA are (1) to disconnect any TOF and (2) to establish a conduit for swallowing, preferably using the native oesophageal segments. This chapter seeks to discuss OA by focusing on the embryology, anatomy and physiology of the oesophagus, stressing on the embryological basis of OA. Other areas to cover include aetiology, pathogenesis, epidemiology, pathologic classification, associated anomalies, pathophysiology, clinical presentation and diagnosis. Further discussion will focus on prognostic classification of patients, management and post-operative complications.

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Delayed diagnosis: An important prognostic factor for oesophageal atresia in developing countries

Cited by 7 publications

References 18 publications

Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia

Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia

Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?

Oesophageal Atresia: Drowning a Child in His/Her Own Saliva

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