Prenatal Diagnosis of Esophageal Atresia – Performance and Consequences

Abstract

BackgroundPrenatal 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. MethodWe 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. ResultsTwenty-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. ConclusionPrenatally 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.