Maturational dysautonomia and facial anomalies associated with esophageal atresia: Support for neural crest involvement

Cozzi, Francesco; Myers, N. A.; Piacenti, S.; Orfei, P; Cozzi, Denis A.; Bonanni, M.; Madonna, L.

doi:10.1016/0022-3468(93)90330-n

Cited by 23 publications

(10 citation statements)

References 20 publications

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“…These findings, i.e. the association with maturational dysautonomia and facial anomalies, suggest that EA should be included among the pharyngeal arch neurocristopathies (3).…”

mentioning

confidence: 81%

Pattern of Cardiovascular Anomalies Associated with Esophageal Atresia: Support for a Caudal Pharyngeal Arch Neurocristopathy

et al. 2001

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Patients with cephalic neurocristopathy (an abnormality of neural crest differentiation) present a striking pattern of associated cardiovascular anomalies (CVA). Therefore, to support the hypothesis that esophageal atresia (EA) may be related to a defective contribution from the cephalic neural crest, we studied the pattern of CVA associated with EA. Medical records of 99 patients with isolated EA, 101 with isolated anorectal malformations (ARM) and 15 with both EA and ARM, consecutively admitted to our unit, were reviewed. The prevalence and pattern of CVA associated with isolated EA or isolated ARM were compared on the assumption that the cranial or caudal location of a major malformation is related to a different regional patterning of associated anomalies. The prevalence of CVA was 39% in patients with isolated EA and 7% in those with isolated ARM (p Ͻ 0.01). Neural crest-related CVA (aortic arch anomalies, conotruncal defects, and superior vena cava malformations) accounted for 72% of all CVA in patients with isolated EA versus 14% in those with isolated ARM (p Ͻ 0.02). In patients with isolated EA, anomalies of the fourth and sixth aortic arch derivatives accounted for 75% of all neural crest related CVA. The present pattern of CVA in infants with EA supports the concept that EA may be related to an abnormal contribution from caudal portion of cephalic neural crest. Nearly all infants with EA present with clinical manifestations of a maturational dysautonomia (1). The autonomic disturbances are similar to those found in infants with PierreRobin or Di George syndromes, which are considered pharyngeal arch syndromes related to a cephalic neurocristopathy (an abnormality of cephalic neural crest differentiation) (2). In addition, Ͼ90% of patients with EA present with one or more minor facial anomalies, which are considered markers of an abnormal developmental activity of the cephalic neural crest (3). These findings, i.e. the association with maturational dysautonomia and facial anomalies, suggest that EA should be included among the pharyngeal arch neurocristopathies (3).To test this hypothesis, we studied, in a large series of patients with EA, the prevalence of aortic arch and conotruncal heart anomalies, which are considered the most distinctive CVA of Di George syndrome (4 -6). These defects appear to be related to an abnormal participation of the cephalic neural crest, inasmuch as ablation of cardiac neural crest, in chick embryos, invariably results in aortico-pulmonary septation defects associated with anomalies of the great arteries (7-10). METHODSThe records of 114 patients with EA and 116 with ARM, consecutively admitted to our unit between 1967 and 1998, were retrospectively reviewed. We decided to compare the prevalence and the pattern of CVA associated with EA with those associated with ARM, on the assumption that these two abnormalities should have a different pattern of associated anomalies. Actually, abnormal development of the cephalic neural crest may result in face, thymus, thyroid, parath...

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“…These findings, i.e. the association with maturational dysautonomia and facial anomalies, suggest that EA should be included among the pharyngeal arch neurocristopathies (3).…”

mentioning

confidence: 81%

Pattern of Cardiovascular Anomalies Associated with Esophageal Atresia: Support for a Caudal Pharyngeal Arch Neurocristopathy

et al. 2001

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“…The midline facial defects along with some respiratory features revealing a dysfunction of the autonomic nervous system also described by other authors have been interpreted as suggestive of an NC pattern for EA-TEF [76][77][78][79].…”

Section: Esophageal Atresia-tracheoesophageal Fistulamentioning

confidence: 85%

The neural crest in pediatric surgery

Tovar

2007

Journal of Pediatric Surgery

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“…One or more of these dysautonomic features are found in nearly all patients with esophageal atresia [1][2][3], suggesting that autonomic disturbances and esophageal atresia may be manifestations of maldevelopment of cephalic neural crest derivates (neurocristopathy) [3]. This theory is supported by the findings that about three fourths of patients with esophageal atresia, such as the present patients with asymmetric sweating and/or flushing, present a neural crest related cardiovascular anomaly [11] and an asymmetric facial defect [3]. Quite independently, the possible role of neural crest cells in the causation of recurrent episodes of flushing and sweating limited to the hemi body of an adult patient, has been recently advanced [12].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperthermia was diagnosed in those infants who presented recurrent episodes of high body temperature without clinical or laboratory evidence of infection [1][2][3]. Apparent life-threatening episode (ALTE) was defined as respiratory arrest which prompted resuscitation maneuvers [1][2][3].…”

Section: Methodsmentioning

confidence: 99%