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Simplifying the Waterston's stratification of infants with tracheoesophageal fistula
J C Dunn1, E W Fonkalsrud, J B Atkinson
1Division of Pediatric Surgery, University of California at Los Angeles School of Medicine 90095, USA.
Insights
The Waterston classification for infants with tracheoesophageal fistula needs updating. Combining Groups A and B simplifies risk stratification, improving outcomes for high-risk infants.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- The Waterston classification (1962) stratifies infants with tracheoesophageal fistula (TEF) to guide surgical timing.
- Its current applicability in modern neonatal care warrants re-evaluation.
Purpose of the Study:
- To assess the contemporary relevance of the Waterston classification system.
- To identify factors influencing survival rates in infants with esophageal atresia and/or TEF.
Main Methods:
- Retrospective review of 64 infants diagnosed with esophageal atresia and/or TEF.
- Analysis of survival rates based on Waterston risk groups, birth weight, and presence of additional anomalies.
Main Results:
- Overall survival rate was 81%. Infants in Waterston Groups A and B had 100% survival, while Group C had 43% survival.
- Low birth weight (<1800g) and severe additional anomalies were identified as primary risk factors for mortality.
- Mortality causes included withdrawal of care, cardiopulmonary arrest, and sepsis.
Conclusions:
- The Waterston classification can be simplified by merging Groups A and B into a single risk stratum.
- Current risk stratification for TEF should prioritize birth weight and associated anomalies over the traditional Waterston groups.
Abstract:
The survival of infants with tracheoesophageal fistula was stratified by David J. Waterston et al. in 1962. This classification has been used as a guide to direct the timing of operative intervention in these infants. This study examines the current applicability of this classification system. The hospital records of 64 infants with esophageal atresia and/or tracheoesophageal fistula were reviewed. The survival rate was analyzed as a function of the infants' risk stratification, birth weight, and additional anomalies. Twenty-three infants were in Waterston Group A, 20 infants in Group B, and 21 infants in Group C. The survival of all infants was 81 per cent. Six infants died after recognition of severe anomalies and withdrawal of care, four infants died of cardiopulmonary arrest, and two infants died of sepsis. The survival of infants in both Groups A and B was 100 per cent, in contrast to 43 per cent survival in Group C. Only infants who weighed <1800 g or had severe additional anomalies were at risk of dying. Therefore, the classification of infants with esophageal atresia and/or tracheoesophageal fistula may be simplified by combining Waterston's Groups A and B into a single risk stratum.