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Oesophageal atresia is correctable and survivable in infants less than 1 kg
Edward J Hannon1,2, Jennifer Billington1, Edward M Kiely1
1Department of Paediatric and Neonatal Surgery, Great Ormond Street Hospital, London, UK.
Insights
Survival rates for extremely low birth weight (ELBW) infants with esophageal atresia (OA) and tracheoesophageal fistula (TOF) show that 50% survival is achievable under 1kg. Infants under 800g had poor outcomes and may require separate classification.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Anomalies
Background:
- Management of esophageal atresia (OA) and tracheoesophageal fistula (TOF) in low birth weight infants presents significant challenges, particularly with co-occurring anomalies.
- Historically, birth weight <1500g was a factor in outcome classification systems, alongside cardiac status.
- Advances in neonatal care have improved survival rates for premature, low birth weight infants.
Purpose of the Study:
- To evaluate the institutional experience with extremely low birth weight (ELBW) infants diagnosed with OA/TOF.
- To assess survival rates and outcomes in this vulnerable patient population.
Main Methods:
- A retrospective review of the institution's OA database from 1993 to June 2015 was conducted.
- Inclusion criteria focused on patients with a birth weight <1000g.
- Data collected included gestation, birth weight, associated anomalies, surgical procedures, morbidity, and mortality.
Main Results:
- Nine ELBW patients (<1000g) were identified, with a 56% overall survival rate (5/9).
- The number of ELBW OA/TOF patients doubled in the latter half of the study period, suggesting improved neonatal care.
- Infants <800g (n=3) all experienced mortality due to cardiac issues, necrotizing enterocolitis, or intraventricular hemorrhage.
Conclusions:
- A 50% survival rate is attainable for OA/TOF infants weighing under 1kg, with the Spitz classification remaining applicable to this broader group.
- Current classification systems may not accurately predict outcomes for infants weighing less than 800g.
- It is recommended that infants <800g be considered a distinct group for outcome prediction in OA/TOF management.
Introduction:
Management of oesophageal atresia (OA) and trachea-oesophageal fistula (TOF) in babies of low birth weight is challenging especially when associated with other anomalies. Birth weight of <1500 g has previously formed part of a classification system designed to predict outcome, alongside the cardiac status of the patient. Improvements in neonatal care have led to increasing numbers of premature low birth weight infants surviving. The aim of this study was to look at the experience of our institution in the extremely low birth weight (ELBW) patients.
Methods:
A retrospective review of our institutions OA database was performed from 1993 to June 2015. Patients of birth weight less than 1000 g were included. A review of our OA/TOF clinical database and notes review established the following; gestation, birth weight, associated anomalies, operative procedures, morbidity and mortality.
Results:
Of 349 patients with OA across the 22-year period, 9 ELBW patients were identified (<1000 g). Six males and three females. Gestational age ranged from 23 to 34 weeks and median birth weight was 815 g ranging from 630 to 950 g. Overall survival was 56 % (5/9). There were double the numbers of ELBW OA/TOF patients seen in the second half of the study period presumably the result of improving neonatal care. Seven patients had type C OA with TOF and underwent emergency TOF ligation, two had concomitant oesophageal repair. One of these patients died from NEC; the other survived. Of the five who had isolated TOF ligation three died-two from cardiac disease and one from prematurity. Both type A patients survived and after initial gastrostomy placement one had a primary delayed repair, the other a gastric transposition. All three babies under 800 g died-one from cardiac disease the others from conditions indicative of their prematurity-necrotising enterocolitis and intraventricular haemorrhage.
Conclusions:
50 % survival is achievable in OA/TOF under 1 kg and the Spitz classification is still applicable in this group as a whole. However, none of the current classification systems are applicable in infants <800 g who in our study all had poor outcomes. We suggest these should be considered as separate group when predicting outcomes.
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