The diagnosis of fetal esophageal atresia and its implications on perinatal outcome

Shaun M. Kunisaki, Steven W. Bruch, Ronald B. Hirschl, George B. Mychaliska, Marjorie C. Treadwell, Arnold G. Coran

Research output: Contribution to journalReview articlepeer-review

Abstract

The current diagnostic accuracy and perinatal outcome of fetuses with esophageal atresia (EA) continues to be debated. In this review, we report on our experience at a tertiary care fetal center with the prenatal ultrasound diagnosis of EA. Enrollment criteria included a small/absent stomach bubble with a normal or elevated amniotic fluid index between 2005 and 2013. Perinatal outcomes were analyzed and compared to postnatally diagnosed EA cases. Of the 22 fetuses evaluated, polyhydramnios occurred in 73 %. Three (14 %) died in utero or shortly after birth, but none had EA. In the presence of an absent/small stomach and polyhydramnios, the positive predictive value for EA was 67 %. In fetal EA cases confirmed postnatally (group 1, n = 11), there were no differences in gestational age, birthweight, or mortality when compared to postnatally diagnosed infants (group 2, n = 59). Group 1 was associated with long-gap EA, need for esophageal replacement, and increased hospital length of stay. When taken in context with the current literature, we conclude that ultrasound findings suggestive of EA continue to be associated with a relatively high rate of false positives. However, among postnatally confirmed cases, there is an increased risk for long-gap EA and prolonged hospitalization.

Original languageEnglish (US)
Pages (from-to)971-977
Number of pages7
JournalPediatric surgery international
Volume30
Issue number10
DOIs
StatePublished - Oct 2014
Externally publishedYes

Keywords

  • Esophageal atresia
  • Fetal imaging
  • Prenatal diagnosis
  • Tracheoesophageal fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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