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Outcomes of Premature Infants With Type C Esophageal Atresia
Annie Le-Nguyen1, Émilie Kate Landry2, Prévost Jantchou3
1Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
Insights
Premature infants with type C esophageal atresia (EA) show similar short-term outcomes to term infants, but prematurity increases the risk of recurrent fistula and prolonged feeding support. Delayed surgery in preterm infants is linked to complications.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Type C esophageal atresia (EA) presents unique challenges in premature infants.
- Understanding outcomes in this vulnerable population is crucial for optimizing care.
Purpose of the Study:
- To compare the postoperative outcomes of premature infants with type C EA to those of term infants.
- To identify specific challenges and complications associated with prematurity in type C EA management.
Main Methods:
- Retrospective cohort study analyzing patient charts from 1992 to 2022.
- Comparison of outcomes between premature and term infants with type C EA.
- Subgroup analysis of preterm infants based on birth weight (very low birth weight vs. >1,500g) and timing of anastomosis (primary vs. delayed).
Main Results:
- Premature infants (67/192) had similar short-term postoperative outcomes to term infants, except for a higher rate of recurrent fistula (16% vs. 6%).
- Prematurity was associated with increased long-term enteral tube feeding (56% vs. 10%) and parenteral nutrition, and a longer hospital stay (50 vs. 17 days).
- Delayed surgery in preterm infants correlated with post-operative leaks, strictures, recurrent fistula, prolonged feeding support, and gastrostomy insertion. Very low birth weight infants showed no significant differences in outcomes compared to other preterm infants.
Conclusions:
- Premature infants with type C EA/TEF experience comparable postoperative outcomes to term infants, despite higher rates of prematurity-related comorbidities.
- Recurrent fistula is more frequent in premature infants with type C EA.
- Delayed anastomosis in preterm infants is associated with adverse postoperative outcomes, highlighting the importance of timely surgical intervention.
Background:
To review the outcomes of premature patients with type C esophageal atresia (EA).
Methods:
In this retrospective cohort study, charts of patients of type C EA patients were reviewed from 1992 to 2022. Outcomes of premature patients were compared to term patients. Preterm patients were analyzed to compare outcomes of infants with very low birth weights (VLBW) to patients >1,500 g as well as primary versus delayed anastomosis.
Results:
Among 192 type C EA, 67 were premature. Median and interquartile range (IQR) gestational age and birth weight of preterm patients were 34 [33-36] weeks and 1965 [1740-2290] g. Delayed anastomosis was performed in 12 (18%) preterm vs. 3 (2%) term patients (p = 0.0003). Short-term postoperative outcomes were similar between preterm and term patients, except for recurrent fistula (16% vs. 6%, p = 0.01). Prematurity was associated with an increased need for long-term enteral tube feeding (56% vs. 10%, p = 0.0001) and parenteral nutrition (10 days vs. 0 days, p = 0.0004). The length of stay was 3 times longer when patients were premature (50 days vs. 17 days, p = 0.002). Delayed surgery in preterm patients was associated with post-operative leaks, strictures, recurrent fistula, prolonged enteral tube feeding, and gastrostomy insertion. Patients with very low birth weight (VLBW) were compared to other preterm patients and showed no difference in terms of rate of delayed surgery, and post-operative outcomes.
Conclusion:
Despite increased prematurity-related comorbidities and low birth weight, premature infants with type C EA/TEF have similar post-operative outcomes to term patients though recurrent fistula was more frequent with prematurity.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
III.
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