Results from the French National Esophageal Atresia register: one-year outcome
2 PremUp Foundation
3 Service de Chirurgie Viscérale Pédiatrique
4 CHU Trousseau [APHP]
5 Service Diabétologie [CHU Toulouse]
6 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
7 Hôpital Jeanne de Flandre [Lille]
8 Inflammation: mécanismes et régulation et interactions avec la nutrition et les candidoses
9 Hôpital Bicètre, Service de chirurgie pédiatrique
10 service de chirurgie viscérale pédiatrique [CHRU Nancy]
11 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
12 Service de chirurgie pédiatrique [CHU Strasbourg]
13 Mines Nantes - Mines Nantes
14 TASC - Theory, Algorithms and Systems for Constraints
15 Service de Pédiatrie
16 URCA - Université de Reims Champagne-Ardenne
17 UAABC - Anthropologie Bio-Culturelle
18 Service de Chirurgie et Radiologie Pédiatrique
19 LARGOTEC/CECCOPOP - Laboratoire de recherche sur la gouvernance publique, territoire et communication
20 SNA - EPIS - Système Nerveux Autonome - Epidémiologie, Physiologie, Ingénierie, Santé
21 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
22 Centre Hospitalier Le Mans (CH Le Mans)
23 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
24 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
25 Service Pédiatrie
26 UA - Université d'Angers
27 Service de chirurgie pédiatrique [CHU Besançon]
28 CHU Nice - Centre Hospitalier Universitaire de Nice
29 Service de Chirurgie infantile
30 CHU Clermont-Ferrand
31 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
32 Hôpital Jeanne de Flandres
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- IdHAL : dominique-weil
- ORCID : 0000-0001-7630-1772
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Résumé
BACKGROUND: The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).
METHODS: All 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.
RESULTS: From 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).
CONCLUSIONS: Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.