Delayed diagnosis: An important prognostic factor for oesophageal atresia in developing countries

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Public Health

Background:

• Esophageal atresia (OA) poses significant risks to newborns.
• Delayed diagnosis is a critical issue, particularly in developing nations.
• Existing prognostic classifications for OA may not fully capture all contributing factors.

Purpose of the Study:

• To analyze the impact of delayed diagnosis on mortality rates in OA patients.
• To evaluate delayed diagnosis as a novel prognostic factor for OA.
• To develop and validate a new classification system for predicting OA prognosis.

Main Methods:

• Retrospective review of 80 OA patient records (2008-2013).
• Patients categorized based on diagnosis timing.
• Development of a new prognostic classification incorporating birth weight, anomalies, and diagnosis delay.
• Comparison of the new classification's discriminatory ability against established systems (Waterston, Montreal, Spitz) using AUC.

Main Results:

• A new classification system was developed with parameters: birth weight (<2000g), major anomalies, and delayed diagnosis.
• Class I: 0-1 parameter; Class II: 2-3 parameters.
• The novel classification demonstrated superior discriminatory ability (AUC) in predicting OA prognosis compared to existing methods.

Conclusions:

• Delayed diagnosis of OA is a significant contributor to morbidity and mortality.
• Despite being a healthcare system issue, delayed diagnosis is an independent prognostic factor for OA.
• The newly developed classification system offers improved prognostic accuracy for OA patients.