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Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Introduction: Primary repair of esophageal atresia (EA) in infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) has been widely performed in pediatric surgery. However, several studies have shown that complication rates in infants with VLBW are high. We hypothesize preterm...

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Autores principales: Ritz, Laura Antonia, Widenmann-Grolig, Anke, Jechalke, Stefan, Bergmann, Sandra, von Schweinitz, Dietrich, Lurz, Eberhard, Hubertus, Jochen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705242/
https://www.ncbi.nlm.nih.gov/pubmed/33282800
http://dx.doi.org/10.3389/fped.2020.587285
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author Ritz, Laura Antonia
Widenmann-Grolig, Anke
Jechalke, Stefan
Bergmann, Sandra
von Schweinitz, Dietrich
Lurz, Eberhard
Hubertus, Jochen
author_facet Ritz, Laura Antonia
Widenmann-Grolig, Anke
Jechalke, Stefan
Bergmann, Sandra
von Schweinitz, Dietrich
Lurz, Eberhard
Hubertus, Jochen
author_sort Ritz, Laura Antonia
collection PubMed
description Introduction: Primary repair of esophageal atresia (EA) in infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) has been widely performed in pediatric surgery. However, several studies have shown that complication rates in infants with VLBW are high. We hypothesize preterm children benefit from a shorter, less-traumatizing operation in the first days of life, as staged repair implies. Methods: Patients with EA and VLBW were retrieved from the database of a large national patient organization KEKS e.V. Structured questionnaires were sent to all the patients' families; the responses were pseudonymized and sent to our institution. Results: Forty-eight questionnaires from patients were analyzed. The mean birth weight was 1,223 g (720–1,500 g). Primary repair was performed in 25 patients (52%). Anastomotic insufficiency (AI) was reported in 9 patients (19%), recurrent fistula (RF) in 8 (17%), and anastomotic stenosis in 24 patients (50%). Although AI was almost twice as common after primary repair than after staged repair (24 vs. 13%; p = 0.5), the difference was not statistically significant. RF was more frequent after primary repair (28 vs. 4%; p = 0.04), gastroesophageal reflux was more frequent in the group after staged repair (78 vs. 52%; p = 0.04), and both correlations were statistically significant. Intracranial hemorrhage (ICH) was reported in 11 patients (23%) and was observed in 7 of them (64%, p = 0.4) after primary repair. ICH was reported in 60% of patients with ELBW and 75% of patients when ELBW was paired with primary repair. Conclusion: This study demonstrates the complication rate in patients with VLBW is higher than the average of that in patients with EA. The study indicates that a staged approach may be an option in this specific patient group, as less RF and AI are seen after staged repair. ICH rate in patients with ELBW seemed to be especially lower after staged repair. Interestingly, gastroesophageal reflux was statistically significantly higher in the group after staged repair, and postoperative ventilation time was longer. It is therefore necessary to individually consider which surgical approach is appropriate for this special patient group.
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spelling pubmed-77052422020-12-03 Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g) Ritz, Laura Antonia Widenmann-Grolig, Anke Jechalke, Stefan Bergmann, Sandra von Schweinitz, Dietrich Lurz, Eberhard Hubertus, Jochen Front Pediatr Pediatrics Introduction: Primary repair of esophageal atresia (EA) in infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) has been widely performed in pediatric surgery. However, several studies have shown that complication rates in infants with VLBW are high. We hypothesize preterm children benefit from a shorter, less-traumatizing operation in the first days of life, as staged repair implies. Methods: Patients with EA and VLBW were retrieved from the database of a large national patient organization KEKS e.V. Structured questionnaires were sent to all the patients' families; the responses were pseudonymized and sent to our institution. Results: Forty-eight questionnaires from patients were analyzed. The mean birth weight was 1,223 g (720–1,500 g). Primary repair was performed in 25 patients (52%). Anastomotic insufficiency (AI) was reported in 9 patients (19%), recurrent fistula (RF) in 8 (17%), and anastomotic stenosis in 24 patients (50%). Although AI was almost twice as common after primary repair than after staged repair (24 vs. 13%; p = 0.5), the difference was not statistically significant. RF was more frequent after primary repair (28 vs. 4%; p = 0.04), gastroesophageal reflux was more frequent in the group after staged repair (78 vs. 52%; p = 0.04), and both correlations were statistically significant. Intracranial hemorrhage (ICH) was reported in 11 patients (23%) and was observed in 7 of them (64%, p = 0.4) after primary repair. ICH was reported in 60% of patients with ELBW and 75% of patients when ELBW was paired with primary repair. Conclusion: This study demonstrates the complication rate in patients with VLBW is higher than the average of that in patients with EA. The study indicates that a staged approach may be an option in this specific patient group, as less RF and AI are seen after staged repair. ICH rate in patients with ELBW seemed to be especially lower after staged repair. Interestingly, gastroesophageal reflux was statistically significantly higher in the group after staged repair, and postoperative ventilation time was longer. It is therefore necessary to individually consider which surgical approach is appropriate for this special patient group. Frontiers Media S.A. 2020-11-17 /pmc/articles/PMC7705242/ /pubmed/33282800 http://dx.doi.org/10.3389/fped.2020.587285 Text en Copyright © 2020 Ritz, Widenmann-Grolig, Jechalke, Bergmann, von Schweinitz, Lurz and Hubertus. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Ritz, Laura Antonia
Widenmann-Grolig, Anke
Jechalke, Stefan
Bergmann, Sandra
von Schweinitz, Dietrich
Lurz, Eberhard
Hubertus, Jochen
Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title_full Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title_fullStr Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title_full_unstemmed Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title_short Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)
title_sort outcome of patients with esophageal atresia and very low birth weight (≤ 1,500 g)
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705242/
https://www.ncbi.nlm.nih.gov/pubmed/33282800
http://dx.doi.org/10.3389/fped.2020.587285
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