New prognostic classification and managements in infants with esophageal atresia

Yamoto, Masaya; Nomura, Akiyoshi; Fukumoto, Koji; Takahashi, Toshiaki; Nakaya, Kengo; Sekioka, Akinori; Yamada, Yutaka; Urushihara, Naoto

doi:10.1007/s00383-018-4322-5

Cited by 15 publications

(9 citation statements)

References 27 publications

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“…All three patients with recurrent TEF underwent revisional surgery for fistula ligation. Anastomotic stricture was treated with endoscopic dilatations in all cases (median 5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] dilatations).…”

Section: Resultsmentioning

confidence: 99%

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Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

et al. 2020

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Background: The aim of this study was to evaluate anastomotic complications after primary one-staged esophageal atresia (EA) repair relating to the patients`gestational age (GA). Methods: Retrospective data analyses of patients who underwent closure of tracheoesophageal fistula (TEF) and primary esophageal anastomosis from 01/2007 to 12/2018 in two pediatric surgical centers. Exclusion of EA other than Gross type C, long-gap EA, minimal invasive or staged approach. Postoperative complications during the first year of life were assessed. Associated malformations, the incidence of infant respiratory distress syndrome (IRDS) and intraventricular bleeding were analyzed. Results: Inclusion of 75 patients who underwent primary EA repair. Low GA was associated with significantly lower incidence of anastomotic complications (p = 0.019, r = 0.596, 95% CI 0.10-0.85). Incidence of anastomotic leakage (0% vs. 5.5%; p = 0.0416), recurrent TEF (0% vs. 5.5%; p = 0.0416) und anastomotic stricture (0% vs. 14.5%; p = 0.0019) was significantly lower in patients < 34 gestational weeks. Incidence of IRDS (55% vs. 0%; p < 0.0001) and intraventricular bleeding (25% vs. 3.6%; p = 0.0299) was significantly higher in patients < 34 gestational weeks. Conclusions: Despite prematurity-related morbidity, low GA did not adversely affect surgical outcome after primary EA repair. Low GA was even associated with a better anastomotic outcome indicating feasibility and safety of primary esophageal reconstruction.

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Section: Resultsmentioning

confidence: 99%

“…Prematurity, birth weight and/or additional anomalies are usually considered crucial factors in determing the outcome of EA/TEF patients [3,5,6,8,9]. Nevertheless, the optimal surgical management of this selective group of patients with EA/TEF remains controversial [4,5,[10][11][12][13][14].…”

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confidence: 99%

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

et al. 2020

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“…2). Летальность в группах составила 0; 7,1; 33,3 и 100 % соответственно [23]. Прогностическая шкала с использованием в качестве основных критериев наличие БВПС и тяжелых ВПР почек также была предложена австралийскими авторами в 2016 г. На основании анализа историй болезни 120 пациентов за период с 1996 по 2014 г. с похожими критериями выборки сформировано 3 группы: 1-я -без больших ВПС и тяжелых врожденных пороков почек; 2-я -с большим ВПС (ОШ 0,044; 95 % ДИ 0,007-0,29; р = 0,001) или с тяжелым ВПР почек (ОШ 0,009; 95 % ДИ 0,001-0.12; p < 0,001); 3-я -с большим ВПС в сочетании с тяжелым ВПР почек.…”

Section: развитые страныunclassified

“…Величина диастаза, соматический статус, сочетанные ВПР, степень недоношенности и в большей степени масса тела при рождении определяют выбор хирургической тактики [9]. Например, в упомянутом ранее исследовании японских коллег [23] авторы не рекомендуют одномоментную операцию у пациентов с нестабильной гемодинамикой или большим диастазом, особенно в III и IV группах (высокого и супервысокого риска соответственно). В то же время A. Shmidt и соавт.…”

Section: развитые страныunclassified

“…Невозможность формирования ЭЭА наблюдалась достоверно чаще в группе глубоко недоношенных детей как в сравнении с недоношенными с массой тела при рождении от 1500 до 2500 г (7/13 и 10/73, p = 0,003), так и доношенными новорожденными (7/13 и 11/112, p = 0,004). Построение логистической регрессии показало, что возможность формирования ЭЭА падает с 91 % при массе тела 3000 г, до 61 и 50 % при массе 1000 и 500 г соответственно [23].…”

Section: развитые страныunclassified

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Esophageal atresia: predicting outcomes and decreasing mortality

Mukhametshin

Фаридович²,

Toropov

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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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.

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Neonatal Surgical Conditions: Congenital Diaphragmatic Hernia and Short Bowel Syndrome

Tan

Currie

Eradi

2020

Emerging Topics and Controversies in Neonatology

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New prognostic classification and managements in infants with esophageal atresia

Abstract: New prognostic classification can improve the stratification of EA patients and be a useful predictor of survival.

Cited by 15 publications

References 27 publications

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

Esophageal atresia: predicting outcomes and decreasing mortality

Neonatal Surgical Conditions: Congenital Diaphragmatic Hernia and Short Bowel Syndrome

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