Management of esophageal atresia and early predictive factors of mortality and morbidity in a developing country

Ammar, Salah; Sellami, Sana; Sellami, I.; Hamad, Amel Ben; Jarraya, A.; Zouari, Mohamed; Zitouni, Hayet; Charfi, Manel; Hbaieb, Manar; Gargouri, Abdellatif; Dhaou, Mahdi Ben; Mhiri, Riadh

doi:10.1093/dote/doy135

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…[5,6] This may be due to our population, which includes critically ill neonates and young infants with severe prematurity and comorbidities, but also to the quality of healthcare. [7,8] The management of these tunneled catheters needs special nursing skills. [9] Safe and successful use of the Broviac and Hickman catheters depends upon the skillful management of a multidisciplinary team [10] that avoids the risks of nosocomial infection, occlusion caused by the precipitation of drugs or parenteral nutrition, and venous thrombosis and stenosis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

et al. 2022

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Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications. Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications. Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2]. Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.

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Section: Discussionmentioning

confidence: 99%

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

et al. 2022

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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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“…Cardiac defects were the most common associated anomaly, with a prevalence of 26.7% ( 22 ). It was reported that cardiac defects were related to mortality ( 22 , 23 ). Preservation of the azygos vein might have less of an effect on the circulatory system than ligation of the azygos vein.…”

Section: Discussionmentioning

confidence: 99%

Azygos vein preservation is feasible and beneficial in esophageal atresia with tracheoesophageal fistula: A meta-analysis of randomized controlled trials

2022

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BackgroundEsophageal atresia (EA) with tracheoesophageal fistula (TEF) is a common congenital anomaly. It is still unknown whether azygos vein preservation will increase the difficulty or time of operation and reduce the quality of anastomosis. Thus, we conducted this meta-analysis to explore the puzzle.MethodsTwo researchers independently searched the databases. Randomized controlled trials were included if these studies applied thoracotomy to perform operations and compared the outcomes in patients with EA/TEF between azygos vein preservation groups and azygos vein ligation groups. The Jadad score was used to assess the quality of the included studies. Statistical heterogeneity was evaluated using the I2 value. A fixed or random-effect model was applied regarding the I2 value.ResultsFour studies involving 286 patients were included. The pooled estimates indicated that preservation of the azygos vein decreased the incidence of anatomic leakage with a pooled risk ratio (RR) of 0.54 (95% CI 0.29–0.99, P = 0.05) and mortality with an RR of 0.51 (95% CI 0.29–0.90; P = 0.02). Preservation of the azygos vein might not require a longer operative time than ligation of the azygos vein.ConclusionsThis research certifies that preservation of the azygos vein is able to reduce the prevalence of anastomotic leakage and mortality.

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Management of esophageal atresia and early predictive factors of mortality and morbidity in a developing country

Cited by 9 publications

References 15 publications

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

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

Azygos vein preservation is feasible and beneficial in esophageal atresia with tracheoesophageal fistula: A meta-analysis of randomized controlled trials

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