RT Journal Article
SR Electronic
T1 Oesophageal atresia: sonographic signs may prenatally predict surgical complexity
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 206
OP 210
DO 10.1136/archdischild-2021-321836
VO 107
IS 2
A1 Tal Weissbach
A1 Anya Kushnir
A1 Ella Haber Kaptsenel
A1 Leah Leibovitch
A1 Ron Bilik
A1 Daniel Shinhar
A1 Gideon Karplus
A1 Reuven Achiron
A1 Zvi Kivilevitch
A1 Eran Barzilay
A1 Shali Mazaki Tovi
A1 Boaz Weisz
A1 Eran Kassif
YR 2022
UL http://fn.bmj.com/content/107/2/206.abstract
AB Objective Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repairMethods Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed.Results Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis.Conclusion OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.All data relevant to the study are included in the article or uploaded as supplementary information.