Outcome of Very Low and Low Birth Weight Infants with Esophageal Atresia: Results of the Turkish Esophageal Atresia Registry

Mustafa O. Oztan; Tutku Soyer; Can I. Oztorun; Binali Firinci; Çiğdem U. Durakbaşa; Zafer Dokumcu; Gulnur Gollu; Ibrahim Akkoyun; Dilek Demirel; Ayşe Karaman; Ilhan Ciftci; Huseyin Ilhan; Ayse Parlak; Onder Ozden; Hatice S. Y. Cömert; Akgun Oral; Gonca Tekant; Gursu Kiyan; Başak Erginel; Unal Guvenc; Ali Onur Erdem; Nazile Erturk; Abdullah Yildiz

doi:10.1055/s-0040-1713663

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2021; 31(03): 226-235
DOI: 10.1055/s-0040-1713663

Original Article

Outcome of Very Low and Low Birth Weight Infants with Esophageal Atresia: Results of the Turkish Esophageal Atresia Registry

Authors

Mustafa O. Oztan

¹Department of Pediatric Surgery, Izmir Katip Celebi University, Izmir, Turkey
Tutku Soyer

²Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
Can I. Oztorun

³Department of Pediatric Surgery, Ankara Yildirim Beyazit Universitesi, Ankara, Turkey
Binali Firinci

⁴Department of Pediatric Surgery, Ataturk University, Erzurum, Turkey
Çiğdem U. Durakbaşa

⁵Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
Zafer Dokumcu

⁶Department of Pediatric Surgery, Ege University, Izmir, Turkey
Gulnur Gollu

⁷Department of Pediatric Surgery, Ankara University, Ankara, Turkey
Ibrahim Akkoyun

⁸Department of Pediatric Surgery, Konya Education and Research Hospital, Konya, Turkey
Dilek Demirel

⁹Department of Pediatric Surgery, Ondokuz Mayıs University, Samsun, Turkey
Ayşe Karaman

¹⁰Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Children Health and Research Application Center, University of Health Sciences, Ankara, Turkey
Ilhan Ciftci

¹¹Department of Pediatric Surgery, Selçuk University, Konya, Turkey
Huseyin Ilhan

¹²Department of Pediatric Surgery, Eskisehir Osmangazi University, Eskisehir, Turkey
Ayse Parlak

¹³Department of Pediatric Surgery, Uludag University, Bursa, Turkey
Onder Ozden

¹⁴Department of Pediatric Surgery, Cukurova University, Adana, Turkey
Hatice S. Y. Cömert

¹⁵Department of Pediatric Surgery, Karadeniz Technical University, Trabzon, Turkey
Akgun Oral

¹⁶Department of Pediatric Surgery, Dr. Behcet Uz Education and Research Hospital, Izmir, Turkey
Gonca Tekant

¹⁷Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Istanbul, Turkey
Gursu Kiyan

¹⁸Department of Pediatric Surgery, Marmara University, Istanbul, Turkey
Başak Erginel

¹⁹Department of Pediatric Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Unal Guvenc

²⁰Department of Pediatric Surgery, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey
Ali Onur Erdem

²¹Department of Pediatric Surgery, Adnan Menderes University, Aydin, Turkey
Nazile Erturk

²²Department of Pediatric Surgery, Mugla Sitki Kocman University Ringgold standard institution, Mugla, Turkey
Abdullah Yildiz

²³Department of Pediatric Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey

Abstract

Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA).

Materials and Methods The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW <1,500 g), LWB = 1,500–2,500 g), and normal BW (NBW; >2,500 g).

Results Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups (p < 0.05). In patients with tracheoesophageal fistula (TEF), patients of the NBW group had significantly higher rates of full oral feedings, when compared with VLBW and LBW cases (p < 0.05). At the end of the first year, when we evaluate all patients, the number of cases with fistula recanalization and esophageal anastomotic strictures (AS) requiring esophageal dilatation was similar among the groups. The weight and height measurements at 6 months and 1 year of age of the survivors were similar in all the groups. The overall mortality rate was significantly higher in the VLBW and LBW groups, when compared with the NBW patients, even in patients with tension-free anastomosis (p < 0.05). The incidence of the associated anomalies was 90.6% in cases with mortality, which was significantly higher than in survivors (59.6%; p < 0.05). According to Spitz's classification, the survival rate was 87.1% in class I, 55.3% in class II, and 16.7% in class III. The most common causes of mortality were associated with cardiovascular diseases, pneumonia, and sepsis.

Conclusion The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.

Keywords

esophageal atresia - national registry - very low birth weight - low birth weight

Full Text

References

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