INFLUENCE OF BIRTH WEIGHT ON PRIMARY SURGICAL MANAGEMENT OF NEWBORNS WITH ESOPHAGEAL ATRESIA
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In brief
In brief
Single-center retrospective study of 198 newborns with EA-TEF shows very low birth weight infants (<1.5kg) face significantly reduced likelihood of achieving primary esophageal anastomosis and higher mortality compared to heavier infants. Birth weight emerges as an independent predictor of surgical feasibility in this population.
Written by the GCMD Library team from the article.
Abstract
Background
To determine if birth-weight (BW) influences primary surgical management of newborns undergoing operation for esophageal atresia and tracheo-esophageal fistula (EA-TEF).
Methods
Newborns undergoing repair of esophageal atresia at a single specialist centre between 1999 and 2017 were categorised into three groups based on BW; Group A < 1.5 kg, Group B <2.5 kg and Group C >2.5 kg. Outcome data analysed were (i) technical ability of the surgeon to perform primary esophageal anastomosis, (ii) anastomotic leak, (iii) anastomotic stricture, (iv) esophageal replacement, (v) need for other procedures notably fundoplication, aortopexy, tracheostomy and (vi) mortality. Statistical analysis was performed using a two-tailed Fisher's exact test and logistic regression.
Results
198 patients underwent surgery for EA-TEF during the study period, Group A (n = 13), Group B (n = 73) and Group C (n = 112). Inability to perform a primary anastomosis was significantly higher in Group A vs Group B (p = 0.003) and Group C (p = 0.004). Birthweight was a significant variable in the ability to perform a primary esophageal anastomosis (OR 1.009, p = 0.004). Mortality rate was significantly higher in Group A vs Group C (P = 0.0158).
Conclusions
Very low birth weight infants are less likely to achieve a definitive primary anastomosis during emergent repair of esophageal atresia, and have a higher mortality.