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Mohammed S, Kamran A, Izadi S, Visner G, Frain L, Demehri FR, Shieh HF, Jennings RW, Smithers CJ, Zendejas B. Primary Posterior Tracheopexy at Time of Esophageal Atresia Repair Significantly Reduces Respiratory Morbidity. J Pediatr Surg 2024; 59:10-17. [PMID: 37903674 DOI: 10.1016/j.jpedsurg.2023.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Esophageal atresia with tracheoesophageal fistula (EA/TEF) is often associated with tracheobronchomalacia (TBM), which contributes to respiratory morbidity. Posterior tracheopexy (PT) is an established technique to treat TBM that develops after EA/TEF repair. This study evaluates the impact of primary PT at the time of initial EA/TEF repair. METHODS Review of all newborn primary EA/TEF repairs (2016-2021) at two institutions. Long-gap EA and reoperative cases were excluded. Based on surgeon preference and preoperative bronchoscopy, neonates underwent primary PT (EA + PT Group) or not (EA Group). Perioperative, respiratory and nutritional outcomes within the first year of life were evaluated. RESULTS Among 63 neonates, 21 (33%) underwent PT during EA/TEF repair. Groups were similar in terms of demographics, approach, and complications. Neonates in the EA + PT Group were significantly less likely to have respiratory infections requiring hospitalization within the first year of life (0% vs 26%, p = 0.01) or blue spells (0% vs 19%, p = 0.04). Also, they demonstrated improved weight-for-age z scores at 12 months of age (0.24 vs -1.02, p < 0.001). Of the infants who did not undergo primary PT, 10 (24%) developed severe TBM symptoms and underwent tracheopexy during the first year of life, whereas no infant in the EA + PT Group needed additional airway surgery (p = 0.01). CONCLUSION Incorporation of posterior tracheopexy during newborn EA/TEF repair is associated with significantly reduced respiratory morbidity within the first year of life. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Gary Visner
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Leah Frain
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Charles J Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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König TT, Stefanescu MC, Wildermuth M, Frankenbach LM, Muensterer OJ, Gianicolo E. Sex-specific percentiles for bodyweight and height in children born with esophageal atresia: a registry-based analysis 2001-2021. BMC Pediatr 2023; 23:27. [PMID: 36650449 PMCID: PMC9847123 DOI: 10.1186/s12887-023-03842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Esophageal atresia (EA) is a rare malformation with a wide range of co-morbidity and associated malformations impairing weight gain and growth. The aim of this study was to calculate specific percentiles for body weight and height for children born with esophageal atresia according to sex from birth to the age of 6 years, accounting for prematurity and presence of congenital heart disease (CHD). METHODS Data was extracted from an anonymized voluntary national registry for patients born with esophageal atresia between 2001 and 2021, from birth until the age of six years. Missing values were imputed using a multiple imputation approach. In premature infants, chronological age was corrected for gestational week until the age of one year. The impact of sex and additional congenital heart disease on weight gain and growth was analysed using quartile regression models. RESULTS In total, 1812 examinations of 485 patients were considered and 1232 examinations of 301 patients were finally included. Most data was available for children at birth and during the first year of life. Body weight was imputed for 3.3% and height for 12.5% of examinations. The mean body weight-for-age and length-for-age at birth according to gestational age was lower in EA patients and median body weight developed along the tenth percentile compared to the general population. Median height-for-age was at the 50th percentile during the first months of life, before crossing to lower percentiles before the age of one year. CHD had an additional negative impact on growth and weight gain, especially during the first year of life. CONCLUSIONS Children with EA had a reduced bodyweight and -height compared to the general population. Therefore, specific percentile curves are helpful to evaluate growth and development. Especially during the first year of life, particular attention is necessary and complications leading to a reduced calorie intake should be treated without delay to promote timely development and growth. Cardiac co-morbidities may further compromise weight gain in these patients, implying that such patients should be under even closer surveillance.
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Affiliation(s)
- Tatjana Tamara König
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Maria-Christina Stefanescu
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Melanie Wildermuth
- Kinder und Erwachsene mit kranker Speiseröhre, KEKS e.V., Stuttgart, Germany
| | - Luisa Maria Frankenbach
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Oliver J. Muensterer
- grid.5252.00000 0004 1936 973XDepartment of Pediatric Surgery, Dr. von Haunersches Kinderspital, Ludwig Maximilian-University Munich, Munich, Germany
| | - Emilio Gianicolo
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin, Johannes Gutenberg-University, Mainz, Germany ,grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, Lecce, Italy
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Zvizdic Z, Becirovic N, Milisic E, Jonuzi A, Terzic S, Vranic S. Epidemiologic and clinical characteristics of selected congenital anomalies at the largest Bosnian pediatric surgery tertiary center. Medicine (Baltimore) 2022; 101:e32148. [PMID: 36482591 PMCID: PMC9726290 DOI: 10.1097/md.0000000000032148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Congenital anomalies (CA) are any abnormality present at birth, either structural or functional, that may potentially affect an infant's health, development, and/or survival. There is a paucity of studies on clinical characteristics and outcomes of CA in Bosnia and Herzegovina, mainly due to the lack of a nationwide congenital malformations monitoring system. A 5-year hospital-based study was conducted to determine the prevalence at birth and clinical characteristics of selected major CA in Sarajevo Canton, Bosnia and Herzegovina. Ninety-one CA were observed from 2012 to 2016 (the overall prevalence was 39.6 cases/10,000 live births). The mean age of neonates at diagnosis was 3 days. The gastrointestinal tract was the most commonly affected system (76.9%), with esophageal atresia (EA) being the most frequent (17.6% of all CA). Major CA were more prevalent among preterm infants than term infants (P = .001), particularly in males (61.5% vs. 38.5%; P = .028; M:F ratio was 1.59). Multiple CA were seen in 37.4% of neonates. The overall mortality rate of neonates was 11%, and the median length of hospital stay was 19.8 days. Our study revealed the distribution and clinical patterns of common major CA in the largest tertiary care facility in Bosnia and Herzegovina. It also confirmed a relatively high mortality rate, which requires further efforts to improve the quality of neonatal care in the country.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Naida Becirovic
- Department of Surgery, General Hospital “Prim. Dr Abdulah Nakas,” Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sabina Terzic
- Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- * Correspondence: Semir Vranic, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar (e-mail: )
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Depoortere S, Lapillonne A, Sfeir R, Bonnard A, Gelas T, Panait N, Rabattu PY, Guignot A, Lamireau T, Irtan S, Habonimana E, Breton A, Fouquet V, Allal H, Elbaz F, Talon I, Ranke A, Abely M, Michel JL, Lirussi Borgnon J, Buisson P, Schmitt F, Lardy H, Petit T, Chaussy Y, Borderon C, Levard G, Cremillieux C, Tolg C, Breaud J, Jaby O, Grossos C, De Vries P, Arnould M, Pelatan C, Geiss S, Laplace C, Kyheng M, Nicolas A, Aumar M, Gottrand F. Nutritional status at age 1 year in patients born with esophageal atresia: A population-based, prospective cohort study. Front Pediatr 2022; 10:969617. [PMID: 35990006 PMCID: PMC9387303 DOI: 10.3389/fped.2022.969617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Despite recent progress in caring for patients born with esophageal atresia (EA), undernutrition and stunting remain common. Our study objective was to assess nutritional status in the first year after birth with EA and to identify factors associated with growth failure. STUDY DESIGN We conducted a population-based study of all infants born in France with EA between 2010 and 2016. Through the national EA register, we collected prenatal to 1 year follow-up data. We used body mass index and length-for-age ratio Z scores to define patients who were undernourished and stunted, respectively. Factors with P < 0.20 in univariate analyses were retained in a logistic regression model. RESULTS Among 1,154 patients born with EA, body mass index and length-for-age ratio Z scores at 1 year were available for about 61%. Among these, 15.2% were undernourished and 19% were stunted at the age of 1 year. There was no significant catch-up between ages 6 months and 1 year. Patients born preterm (41%), small for gestational age (17%), or with associated abnormalities (55%) were at higher risk of undernutrition and stunting at age 1 year (P < 0.05). Neither EA type nor surgical treatment was associated with growth failure. CONCLUSION Undernutrition and stunting are common during the first year after birth in patients born with EA. These outcomes are significantly influenced by early factors, regardless of EA type or surgical management. Identifying high-risk patient groups with EA (i.e., those born preterm, small for gestational age, and/or with associated abnormalities) may guide early nutritional support strategies.
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Affiliation(s)
- Suzanne Depoortere
- Univ. Lille, CRACMO Reference Center for Rare Esophageal Diseases, CHU Lille, INFINITE U1286, Lille, France
| | | | - Rony Sfeir
- Univ. Lille, CRACMO Reference Center for Rare Esophageal Diseases, CHU Lille, INFINITE U1286, Lille, France
| | | | | | | | | | | | | | - Sabine Irtan
- University Hospital APHP Armand Trousseau, Paris, France
| | | | - Anne Breton
- University Hospital of Toulouse, Toulouse, France
| | | | - Hossein Allal
- University Hospital of Montpellier, Montpellier, France
| | | | | | | | - Michel Abely
- University Hospital of Reims, Reims, Champagne-Ardenne, France
| | - Jean-Luc Michel
- University Hospital of La Réunion, Saint Denis de la Réunion, France
| | | | | | | | | | | | - Yann Chaussy
- University Hospital of Besançon, Besançon, France
| | - Corinne Borderon
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Cécilia Tolg
- University Hospital of Fort De France, Martinique, Fort de France, France
| | | | | | | | | | | | | | | | | | - Maéva Kyheng
- CHU Lille-Department of Biostatistics, Lille, France
| | - Audrey Nicolas
- Univ. Lille, CRACMO Reference Center for Rare Esophageal Diseases, CHU Lille, INFINITE U1286, Lille, France
| | - Madeleine Aumar
- Univ. Lille, CRACMO Reference Center for Rare Esophageal Diseases, CHU Lille, INFINITE U1286, Lille, France
| | - Frédéric Gottrand
- Univ. Lille, CRACMO Reference Center for Rare Esophageal Diseases, CHU Lille, INFINITE U1286, Lille, France
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