Analysis of Prognostic Factors and Mortality in Children with Esophageal Atresia

Vukadin, Miroslav; Savić, Djordje; Maliković, Aleksandar; Jovanović, D.; Milickovic, Maja; Bosnic, Srdjan; Vlahovic, Aleksandar M.

doi:10.1007/s12098-015-1730-6

Cited by 21 publications

(23 citation statements)

References 23 publications

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“…This finding was consistent with other reports. [ 13 , 30 ] Another independent risk factor for mortality in the present study was respiratory failure, which was consistent with other findings. [ 4 , 26 ] Respiratory failure caused by gastric fluid reflux into the lungs could increase the risk of mortality.…”

Section: Discussionsupporting

confidence: 93%

“…[ 4 , 26 ] Respiratory failure caused by gastric fluid reflux into the lungs could increase the risk of mortality. [ 6 , 30 ] A low birth weight has already been considered one of the substantial risk factors for mortality in many studies. [ 2 – 6 ] A birth weight less than 1500 g was considered one of the risk indicators in the prognostic classification system established by Spitz et al [ 15 ] A nationwide investigation performed in 2014 indicated that a birth weight less than 1500 g remains an independent predictor of mortality in infants with EA in the United States, and the survival rate in infants whose birth weight was greater than 1500 g was more than 92%.…”

Section: Discussionmentioning

confidence: 99%

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A scoring system to predict mortality in infants with esophageal atresia

Jiang

Wang

et al. 2017

Medicine

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Esophageal atresia (EA) is a rare anomaly that mandates surgical intervention. Patients with EA often have complicated medical courses due to both esophageal anomalies and related comorbidities. Although several prognostic classification systems have been developed to decrease the mortality rate in EA, most systems focus only on the influence of the major anomaly, and external risk factors that could be influenced by the neonatal caregivers to a certain extent are not included. The aim of this study was to investigate the risk factors for in-hospital mortality in neonates with EA and develop a scoring model to predict mortality.In total, 198 infants with EA who were treated with surgical intervention at the Children's Hospital of Chongqing Medical University between March 2004 and June 2016 were included. The demographic information, clinical manifestations, laboratory testing, and outcomes during hospitalization were analyzed retrospectively. A predictive scoring model was developed according to the regression coefficients of the risk factors.The mortality rate was 18.1% (36/198). In the univariate analysis, higher incidences of prematurity, low birth weight, long gap, anastomotic leak, respiratory failure, postoperative sepsis, respiratory distress syndrome, pneumothorax, and septic shock were found in the nonsurvivor group than in the survivor group (P < .05). In the logistic regression analysis, anastomotic leak (OR: 10.75, 95% CI: 3.113–37.128), respiratory failure (OR: 4.104, 95% CI: 2.292–7.355), postoperative sepsis (OR: 3.564, 95% CI: 1.516–8.375), and low birth weight (OR: 8.379, 95% CI: 3.357–20.917) were associated with a high mortality rate. A scoring model for predicting death was developed with a sensitivity of 0.861, a specificity of 0.827, a positive predictive value of 0.524, and a negative predictive value of 0.963 at a cutoff of 2 points. The area under the receiver-operating characteristic curve of the score was 0.905 (95% CI, 0.863–0.948, P = .000) for death from EA. The mortality rate increased rapidly as the scores increased, and all patients with scores ≥5 died.Anastomotic leak, respiratory failure, postoperative sepsis, and low birth weight are independent risk factors for mortality in EA. Infants with a predictive score of 5 had a high risk of death.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

A scoring system to predict mortality in infants with esophageal atresia

Jiang

Wang

et al. 2017

Medicine

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“…The overall outcome of treatment of these patients was poor compared to the outcome in HICs . The poorer outcome in our setting as well as some other developing countries might be related to continuing barriers to care imposed by delayed presentation, inadequate facilities and general lack of funding at both personal and public levels. A closer look at our findings will show that mortality in this series was contributed mostly by conditions such as oesophageal atresia, intestinal atresia and abdominal wall defects where intensive care is critical to good outcome.…”

Section: Discussionmentioning

confidence: 62%

Neonatal surgery in a developing country: Outcome of co‐ordinated interdisciplinary collaboration

Ekenze

Modekwe

Ajuzieogu

et al. 2017

J Paediatrics Child Health

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“…Похожую по дизайну научную работу опубликовали сербские авторы под руководством M. Vukadin в 2015 г. [31]. В исследование включили 60 новорожденных со средней массой тела при рождении 2660 г (1100-4140 г), средним сроком гестации 38 нед.…”

Section: развивающиеся страныunclassified

“…Летальность оказалась выше, чем в развитых странах, и составила 28,3 %. Причиной летального исхода в большинстве случаев был сепсис (p = 0,002), также на выживаемость оказали влияние хирургические осложнения (p = 0,003) [31].…”

Section: развивающиеся страныunclassified

Esophageal atresia: predicting outcomes and decreasing mortality

Mukhametshin

Фаридович²,

Toropov

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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This literature review is devoted to the problem of predicting in-hospital mortality in newborns with esophageal atresia (EA). According to epidemiological study data, in developed countries, the mortality rate in newborns with EA ranges from 9% to 11% over the past 20 years. Three classifications were developed, Waterston 1962, Montreal 1993, and Spitz 1994, to assess the prognostic significance of risk factors. They considered birth weight, the presence of concomitant congenital malformations and pneumonia, and the need for mechanical ventilation. The choice of a model for predicting outcomes depends on the level of health care and other factors, such as prematurity, low birth weight, late diagnosis, and infectious complications. These factors have a greater impact on patient survival in developing countries than in developed ones, where insurmountable risk factors come out on top: combined congenital malformations and very low birth weight. Also, the magnitude of diastasis between segments of the esophagus creates difficulties in choosing surgical tactics and managing such patients in the postoperative period. In addition, the management of such patients in the intensive care unit, both preoperatively and postoperatively, has a significant impact on the outcome. The literature review underlined "pain points" in the treatment of newborns with EA in regions with different levels of medical care, the consideration of which will allow the achievement of better results.

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Analysis of Prognostic Factors and Mortality in Children with Esophageal Atresia

Abstract: Total mortality in newborns with EA was high; sepsis being the most frequent cause of death. The high total mortality was also caused by prematurity, delay in diagnosis, increased incidence of the aspiration pneumonia and shortage of qualified nurses.

Cited by 21 publications

References 23 publications

A scoring system to predict mortality in infants with esophageal atresia

A scoring system to predict mortality in infants with esophageal atresia

Neonatal surgery in a developing country: Outcome of co‐ordinated interdisciplinary collaboration

Esophageal atresia: predicting outcomes and decreasing mortality

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