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Oesophageal atresia: at-risk groups for the 1990s
L Spitz1, E M Kiely, J A Morecroft
1Department of Surgery, Hospital for Sick Children, London, England.
Insights
Infants with oesophageal atresia have improved survival rates. Key predictors of poor outcomes include low birth weight (<1,500g) and major congenital cardiac disease, leading to a refined risk classification.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Neonatal Care
Background:
- Oesophageal atresia and tracheoesophageal fistula are serious congenital anomalies.
- The Waterston classification system has been used to predict outcomes.
Purpose of the Study:
- To analyze outcomes for infants with oesophageal atresia and H-type tracheoesophageal fistula.
- To identify key predictors of mortality.
- To propose a new, refined classification system for predicting outcomes.
Main Methods:
- Retrospective analysis of 357 infants with oesophageal atresia and 15 with H-type tracheoesophageal fistula treated between 1980-1992.
- Evaluation of survival rates based on the Waterston risk categories.
- Identification of risk factors associated with mortality.
Main Results:
- Survival rates were 99% (Group A), 95% (Group B), and 71% (Group C) using the Waterston classification.
- Low birth weight (<1,500g) and major congenital cardiac disease were significant predictors of mortality.
- A new classification system demonstrated distinct survival rates: Group I (97%), Group II (59%), and Group III (22%).
Conclusions:
- Optimal management has significantly improved survival for infants in lower-risk categories.
- The proposed new classification, incorporating birth weight and cardiac anomalies, offers a more accurate prediction of outcomes in oesophageal atresia.
- This refined classification can aid in surgical planning and parental counseling.
Abstract:
The authors analyzed the outcome for 357 infants with oesophageal atresia and 15 with H-type tracheoesophageal fistula treated from 1980 through 1992. Survival according to Waterston risk categories was 99% for group A, 95% for group B, and 71% for group C. Presently, with optimal management, virtually all infants in groups A and B should survive. When examining the risk factors in the infants who died, two criteria were found to be important predictors of outcome: birth weight of less than 1,500 g and the presence of major congenital cardiac disease. A new classification for predicting outcome in oesophageal atresia is proposed: group I: birth weight > or = 1,500 g, without major cardiac disease, survival 97% (283 of 293); group II: birth weight < 1,500 g, or major cardiac disease, survival 59% (41 of 70); and group III: birth weight < 1,500 g, and major cardiac disease, survival 22% (2 of 9).