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Prenatal Diagnosis of Esophageal Atresia - Performance and Consequences
T Arntzen1, A Mikkelsen2, R Emblem1
1Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
Insights
Prenatal diagnosis of esophageal atresia (EA) increased over time, identifying more complex cases. While enabling earlier surgical care, prenatal diagnosis correlated with longer hospital stays and ventilator times in EA patients.
Area of Science:
- Medical research
- Pediatric surgery
- Neonatology
Background:
- Prenatal diagnosis of congenital malformations is generally considered favorable.
- Esophageal atresia (EA) is detected prenatally in 10-40% of cases.
- Factors influencing EA detection rates and outcomes require further investigation.
Purpose of the Study:
- To assess factors influencing the prenatal detection rate of esophageal atresia (EA).
- To compare outcomes in EA patients with and without prenatal diagnosis.
- To analyze trends in EA diagnosis and management over two distinct time periods.
Main Methods:
- A retrospective study of 136 EA patients divided into two groups: 1996-2002 (n=68) and 2014-2020 (n=68).
- Clinical variables, including prenatal signs, and perinatal/postnatal outcomes were extracted from electronic patient records.
- Statistical analysis, including odds ratios and multivariate analysis, was employed to identify significant associations.
Main Results:
- The prenatal diagnosis rate for EA significantly increased from 9% (1996-2002) to 28% (2014-2020).
- EA types A/B and associated anomalies were linked to a higher likelihood of prenatal diagnosis.
- Prenatally diagnosed patients experienced earlier surgical unit arrival but had longer hospital stays and ventilator times, with prenatal diagnosis predicting length of stay.
Conclusions:
- Prenatally diagnosed EA cases often involve more complex malformations (Type A/B) and associated anomalies, leading to increased neonatal morbidity.
- Despite potential benefits like early surgical access, the overall impact of prenatal diagnosis on EA patient outcomes warrants further study.
- The study highlights the need to critically evaluate the consequences of prenatal diagnosis in EA management.
Background:
Prenatal diagnosis of congenital malformations is considered favorable. Esophageal atresia (EA) is prenatally detected in 10-40% of patients. The aims of our study were to assess factors influencing the prenatal detection rate and to study the outcome in EA patients with and without prenatal diagnosis.
Method:
We included 136 patients in two time periods, group 1 (1996-2002, n = 68) and group 2 (2014-2020, n = 68). We registered clinical variables; prenatal signs, perinatal and postnatal outcome from the electronic patient record.
Results:
Twenty-five patients (18%) had a prenatal diagnosis of EA, significantly more during 2014-2020 (28%), than during 1996-2002 (9%). Patients with EA type A or B and with associated anomalies had increased likelihood of prenatal diagnosis, odds ratio (OR) 9.00 (1.99-40.69) and 3.53 (1.24-10.06), respectively. Among the 25 patients with prenatal diagnosis all had polyhydramnios and 16 had small/absent stomach. Prenatally diagnosed patients arrived significantly earlier at the surgical unit (median 2 h (2 h-1 days) vs 21 h (2 h-1275 days)), had more delayed primary anastomosis (OR 8.80 (2.68-28.92)) and anastomotic stricture (OR 3.11 (1.20-8.04)), longer length of stay (median 62 days (11-212 days) vs 20 days (2-270 days)) and longer time on ventilator (median 5 days (1-25 days) vs 1.5 days (0.5-33 days)) compared to patients without prenatal diagnosis. In multivariate analysis prenatal diagnosis predicts length of stay.
Conclusion:
Prenatally diagnosed EA patients have more; type A and B malformations, associated anomalies and neonatal morbidity. Consequences of the assumed benefits of prenatal diagnosis; opportunity of early arrival to surgical care and prenatal counselling, must be further studied.
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