Tracheoesophageal anomalies in waterston C neonates: A 30-year perspective

William E. Wise, Donna A. Caniano, Richard P. Harmel

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)526-529
Number of pages4
JournalJournal of pediatric surgery
Volume22
Issue number6
DOIs
StatePublished - Jun 1987

Keywords

  • Esophageal atresia

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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