Post-operative ventilation strategies after surgical repair in neonates with esophageal atresia: A retrospective cohort study
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In brief
In brief
This retrospective study of 67 neonates with esophageal atresia examined whether post-operative ventilation strategies affect anastomotic leak rates after primary repair. Despite preterm infants requiring more ventilatory support, no significant difference in leak rates was found across different ventilation approaches.
Written by the GCMD Library team from the article.
Background
Infants affected by Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) may require non-invasive ventilation (NIV) in the post-operative period after elective extubation, especially if born preterm. The aim of the paper is to evaluate the role of different ventilation strategies on anastomotic complications, specifically on anastomotic leak (AL).
Materials and Methods
Retrospective single Institution study, including all consecutive neonates affected by EA with or without TEF in a 5-year period study (from 2014 to 2018). Only infants with a primary anastomosis were included in the study. All infants were mechanically ventilated after surgery and electively extubated after 6-7 days. The duration of invasive ventilation was decided on a case-by-case basis after surgery, based on the pre-operative esophageal gap and intraoperative findings. The need for non-invasive ventilation (NCPAP, NIPPV, and HHHFNC) after extubation and extubation failure with the need for mechanical ventilation in the post-operative period were assessed. The primary outcome evaluated was the rate of anastomotic leak.
Results
102 EA/TEF infants were managed in the study period. Sixty-seven underwent primary anastomosis. Of these, 29 (43.3%) were born preterm. Patients who required ventilation (n= 32) had a significantly lower gestational age as well as birthweight (respectively p=0.007 and p=0.041). 4/67 patients had an AL after surgical repair, with no statistical differences among post-operative ventilation strategies.
Conclusion
We found no significant differences in the rate of anastomotic leak (AL) according to post-operative ventilation strategies in neonates operated on for EA/TEF.