Does a combination of ultrasound, MRI, and biochemical amniotic fluid analysis improve prenatal diagnosis of esophageal atresia?

Abstract

In case of ultrasound prenatal suspicion of EA (with or without visualization of the pouch sign), an MRI at 30-32 weeks using fast imaging employing steady-state acquisition should be proposed. Biochemical amniotic fluid may be helpful and should be evaluated in a larger study.

Performance of prenatal diagnosis in esophageal atresia

“…There are few studies evaluating biochemistry of the amniotic fluid in EA . Muller et al showed that digestive enzymes were abnormal in amniotic fluid in case of EA.…”

“…They described an EA index with a threshold of 3 allowing 98% of sensibility and 100% of specificity . Using this EA index, Garabadian et al observed 90% of sensibility and 60% of specificity . Because of our study design, we confirm the high sensitivity of amniotic fluid biochemistry (sensitivity 88.2%), but we cannot study the specificity because all cases were EA, and therefore, there were no false‐positive cases.…”

“…20 There are few studies evaluating biochemistry of the amniotic fluid in EA. [14][15][16] Muller et al showed that digestive enzymes were abnormal in amniotic fluid in case of EA. They described an EA index with a threshold of 3 allowing 98% of sensibility and 100% of specificity.…”

“…The value of ultrasound, MRI, and biochemistry of the amniotic fluid in the prenatal diagnosis of EA has already been evaluated in prenatal series, which are usually in selected population, but rarely from postnatal series . In this pragmatic study, we investigated the performance of prenatal diagnosis of EA from a postnatal cohort of infants managed in the pediatric/neonatal intensive care unit.…”

“…12,14,15 The value of ultrasound, MRI, and biochemistry of the amniotic fluid in the prenatal diagnosis of EA has already been evaluated in prenatal series, which are usually in selected population, but rarely from postnatal series. 14,16,17 In this pragmatic study, we investigated the performance of prenatal diagnosis of EA from a postnatal cohort of infants managed in the pediatric/neonatal intensive care unit. We evaluated the relevance of ultrasound in the prenatal detection of EA and of associated anomalies, and we also evaluated the performance of second-line tools such as MRI and biochemistry of the amniotic fluid.…”