BackgroundThe aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).MethodsAll 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database.ResultsFrom the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33–398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was −0.8 (range, −5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007).ConclusionsDigestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-014-0206-5) contains supplementary material, which is available to authorized users.
de Vries P, Soret R, Suply E, Heloury Y, Neunlist M. Postnatal development of myenteric neurochemical phenotype and impact on neuromuscular transmission in the rat colon. Am J Physiol Gastrointest Liver Physiol 299: G539 -G547, 2010. First published June 3, 2010 doi:10.1152/ajpgi.00092.2010.-Profound changes in intestinal motility occur during the postnatal period, but the involvement of the enteric nervous system (ENS), a key regulator of gastrointestinal (GI) motility, in these modifications remains largely unknown. We therefore investigated the postnatal development of the ENS phenotype and determined its functional repercussion on the neuromuscular transmission in the rat colon. Sprague-Dawley rats were euthanized at postnatal day (P) 1, P3, P5, P7, P14, P21, and P36. Whole mounts of colonic myenteric plexus were stained with antibodies against choline acetyltransferase (ChAT), neuronal nitric oxide synthase (nNOS), and HuC/D. Colonic contractile response induced by electrical field stimulation (EFS) was investigated in organ chambers in absence or presence of N-nitro-L-arginine methyl ester (L-NAME) and/or atropine. In vivo motility was assessed by measurement of the colonic bead latency time. Randomly occurring ex vivo contractions appeared starting at P5. Starting at P14, rhythmic phasic contractions occurred whose frequency and amplitude increased over time. In vivo, bead latency was significantly reduced between P14 and P21. Ex vivo, EFS-induced contractile responses increased significantly over time and were significantly reduced by atropine starting at P14 but were sensitive to L-NAME only after P21. The proportion of ChATimmunoreactive (IR) neurons increased time dependently starting at P14. The proportion of nNOS-IR neurons increased as early as P5 compared with P1 but did not change afterward. Our data support a key role for cholinergic myenteric pathways in the development of postnatal motility and further identify them as putative therapeutic target for the treatment of GI motility disorders in the newborn. postnatal development; enteric nervous system; myenteric plexus; rat; motility; neonates THE POSTNATAL PERIOD is a key period of life and is particularly sensitive to the influence of various environmental factors. This period is characterized by the maturation of various organs and in particular of the gut. Indeed, various gastrointestinal (GI) functions such as intestinal barrier function or motility continue their maturation and development after birth. This is particularly true in rodents such as rats or mice, making them good models for studying GI dysfunctions observed in preterm infants, such as constipation (2).Among the key regulators of GI functions is the enteric nervous system (ENS). The ENS has been shown to control GI motility and intestinal barrier functions (22). Cholinergic excitatory motor neurons [identified as choline acetyltransferase (ChAT)-immunoreactive (IR)] and often colocalized with substance P and nitrergic inhibitory motor neurons [identified as neuronal nitric ox...
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