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Results from the French National Esophageal Atresia register: one-year outcome
Anne Schneider1, Sébastien Blanc, Arnaud Bonnard
1Reference Center for Congenital Esophageal Anomalies, University Hospital Lille, Avenue Eugène Avinée, Lille, 59037, France. schneider.an@orange.fr.
Insights
Early morbidity in esophageal atresia (EA) is common, with many infants experiencing complications like stenosis and requiring rehospitalization. Factors such as difficult anastomosis and lack of oral feeding increase risks for these infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Esophageal atresia (EA) is a congenital condition requiring surgical correction.
- Early morbidity assessment is crucial for optimizing outcomes in EA patients.
Purpose of the Study:
- To evaluate the early morbidity and 1-year outcomes in a national cohort of esophageal atresia patients.
- Identify factors associated with medical complications in infants with EA.
Main Methods:
- Prospective, population-based study involving 38 French multidisciplinary centers.
- Data collected via questionnaires on 1-year outcomes for 307 EA patients born in 2008-2009.
- Centralized database for information verification and entry.
Main Results:
- 301 (98%) patients had 1-year outcome data; 4% lost to follow-up, 5% died.
- 34% experienced medical complications including anastomotic stenosis (22%) and leaks (8%).
- 59% required rehospitalization for digestive/respiratory issues; 15% were undernourished at 12 months.
Conclusions:
- Digestive and respiratory morbidities are frequent in the first year post-EA repair.
- Difficult anastomosis and insufficient oral feeding at discharge are linked to increased complications.
Background:
The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).
Methods:
All 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database.
Results:
From the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33-398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was -0.8 (range, -5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007).
Conclusions:
Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.