Two hundred and seventy-eight infants with congenital tracheoesophageal anomalies have been managed at the Columbus Children's Hospital since 1955. Fifty-four (20%) have been classified as high risk using Waterston's criteria of birth weight, associated anomalies, and pneumonitis. The infants have been divided into group 1 (n=27, 1955 to 1969) and group II (n=27, 1970 to 1984) to reflect the onset of mechanical ventilation and effective neonatal intensive care. The mean birth weight of infants in group II was significantly less than in group I (1,753±390 g v 1,950±505 g, P<.05). The incidence of prematurity, measured by gestational age, has significantly increased with 9 of 27 (33%) infants in group Il and 2 of 27 (7%) infants in group 1<32 weeks gestation (P<.05). The presence or severity of associated anomalies was not significantly different in groups I and II. Twenty patients in group 1 and 22 patients in group II underwent definitive management of their tracheoesophageal anomaly. Operative survival was 30% in group 1 and 74% in group II (P< .05). Long-term survival was 15% in group 1 and 64% in group Il (P<.05). Early postoperative complications included aspiration pneumonitis, anastomotic leak, or stricture. The most frequent complications in long-term followup were recurrent pneumonias, which were observed in 9 of 16 children. Esophageal dysmotility or gastroesophageal reflux was documented in five of these children; four were managed successfully with positional or pharmacologic manipulations while one required an antireflux procedure. Thirty percent (5/16) are asymptomatic. Survival of high-risk neonates with esophageal atresia has steadily improved over the past 30 years. This improved outcome appears to be related to improved neonatal intensive care, early referral to a tertiary care facility, and a period of stabilization prior to definitive operative management. Associated severe anomalies and extreme prematurity appear to be the primary determinants of mortality at the present time.
- Esophageal atresia
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health