Esophageal atresia: Early outcome analysis from a high-volume tertiary care institute in India

Abstract

Context: Despite the progress made in the field of surgical techniques and neonatal care, conditions such as prematurity, very low birth weight, and associated anomalies compounded with delayed diagnosis may negatively influence the successful outcome of esophageal atresia (EA). Aims: The aim is to study the early outcome analysis of patients with EA and tracheoesophageal fistula (TEF) at a high-volume tertiary care institute. Settings and Design: A retrospective study performed from January 2016 to December 2016. Subjects and Methods: The study included all patients of EA and TEF admitted in the Neonatal Intensive Care Unit of our department. Results: There were 430 new cases of EA/TEF. Type C was the most common (90.23%), followed by Type A (8.37%), Type E (0.69%), and one case each of Type D, esophageal web, and esophageal stenosis. Two hundred and twenty-four (52.10%) remained undiagnosed on the 1st day of life. The average birth weight was 2200 g; 64.65% of patients were low birth weight. Associated major anomalies were present in 18.84% patients with gastrointestinal tract anomalies in 13.49% cases (anorectal malformation – 11.86%, duodenal atresia [DA] – 2.79%, and triple atresia – 0.93%) and VACTERL association in 11.63%. Surgical procedures were performed in 413 (96.05%) patients. Survival was seen in 29.77% cases, mortality in 68.84% and 1.39% patients left against the medical advice. The survival was better in Type C (29.89%) than Type A (27.78%) and also those without associated anomalies. VACTERL association had a very high (80%)-mortality rate. Septicemia (63.85%), severe pneumonia (53.71%), and congestive heart failure (24.32%) were main causes of mortality. Conclusions: Although there has been a marked improvement in the antenatal diagnosis of EA, most cases in our study remain undiagnosed in first 24 h of birth. Associated major anomalies were documented in approximately 1/5th patients. Survival was present in less than 1/3rd patients; survival outcomes were better in EA without associated anomalies. Early diagnosis with the help of red rubber catheter shortly after birth, measures to prevent pneumonia, strict infection control measures for prevention of septicemia, deployment of sufficient resources, and investigations for other associated anomalies are recommended to improve the outcomes of EA.