Predictors of mortality in newborns with esophageal atresia: a 6-year study in a single institution

  • Leecarlo Milano Department of Surgery, Division of Pediatric Surgery, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java, Indonesia
  • Nunik Agustriani Department of Surgery, Division of Pediatric Surgery, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java, Indonesia
  • Rochadi Rochadi Department of Surgery, Division of Pediatric Surgery, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java, Indonesia
DOI: https://doi.org/10.14238/pi55.3.2015.131-5
Keywords: esophageal atresia, risk factor of mortality, thrombocytopenia, sepsis, anemia

Abstract

Background Esophageal atresia, with or without fistula, is a congenital defect that causes high morbidity and mortality in newborns. Risk factors of mortality need to be identified to establish the best approach for treating this condition in order to decrease morbidity and mortality.
Objective To identify factors associated with mortality in newborns with oesophageal atresia.
Methods We reviewed all newborns with esophageal atresia using data from their medical records at Sardjito General Hospital from January 2007 to December 2012. Potential risk factors were analyzed using Chi-square test, with a level of significance of P<0.05.
Results Of 31 newborns that met our criteria, only 5 survived, and all 5 had one-stage surgery (primary anastomosis with fistula ligation). Thrombocytopenia and sepsis increased the risk of death with OR 10.857 (95%CI 1.029 to 114.578) and OR 13.333 (95% CI 1.242 to 143.151), respectively. However, anemia had a protective effect against mortality with OR 0.688 (95%CI 0.494 to 0.957).
Conclusion Thrombocytopenia and sepsis are the risk factors associated with mortality in newborns with esophageal atresia at our institution. Anemia has a protective effect against mortality.

References

Sfeir R, Bonnard A, Khen-Dunlop N, Auber F, Gelas T, Michaud L, et al. Esophageal atresia: data from a national cohort. J Pediatr Surg. 2013;48:1664-9.

Sugito K, Koshinaga T, Hoshino M, Inoue M, Goto H, Ikeda T, et al. Study of 24 cases with congenital esophageal atresia: what are the risk factors? Pediatr Int. 2006;48:616-21.

Lilja HE, Wester T. Outcome in neonates with esophageal atresia treated over the last 20 years. Pediatr Surg Int. 2008;24:531-6.

Petrosyan M, Estrada J, Hunter C, Woo R, Stein J, Ford HR, et al. Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair. J Pediatr Surg. 2009;44:2278-81.

Deurloo JA, de Vos R, Ekkelkamp S, Heij HA, Aronson DC. Prognostic factors for mortality of oesophageal atresia patients: Waterston revived. Eur J Pediatr. 2004;163:624-5.

Deurloo JA, Smit BJ, Ekkelkamp S, Aronson DC. Oesophageal atresia in premature infants: an analysis of morbidity and mortality over a period of 20 years. Acta Paediatr. 2004;93:394-9.

Chandler N, Colombani PM. The esophagus. In: Holcomb III GW, Murphy JP, Ostlie DJ, editors. Aschraft’s pediatric surgery. 5th ed. Philadelphia: Elsevier-Inc; 2010. p. 330-44.

Harmon CM, Coran AG. Congenital anomalies of esophagus. In: Grossfeld JL, O’Neil Jr. JA, Fonkalsrud EW, Coran AG, editors. Pediatric Surgery. 6th ed - Vol 1. Philadelphia: Mosby, Inc; 2006. p. 1051-81.

Spitz L. Oesophageal atresia. Orphanet J Rare Dis. 2007;2:24.

Spitz L. Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg. 2006;41:1635-40.

Deurloo JA, Ekkelkamp S, Schoorl M, Heij HA, Aronson DC. Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg. 2002;73:267-72.

Antonoff M, Marquez T, Saltzman D. Physiology of the newborn. In: Holcomb III GW, Murphy JP, Ostlie DJ, editors. Ashcraft’s Pediatric Surgery. 5th ed. Philadelphia: Elsevier, Inc; 2010. p. 3-31.

Davari HA, Hosseinpour M, Nasiri GM, Kiani G. Mortality in esophageal atresia: assessment of probable risk factors (10 years’ experience). J Res Med Sci. 2012;17:540-2.

Luchtman-Jones L, Wilson DB. The blood and hematopoietic system. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Neonatal-perinatal medicine-diseases of the fetus and infant. 9th ed – Vol 2. St. Louis-Missouri: Elsevier, Inc; 2011. p. 1303-60.

Hutchinson RJ. Surgical implications of hematologic disease. In: Grossfeld JL, O’Neil Jr. JA, Fonkalsrud EW, Coran AG, editors. Pediatric Surgery. 6th ed - Vol 1. Philadelphia: Mosby, Inc; 2006. p. 178-91.

Neville KA, Wicklund BM, Woods GM. Coagulopathies and sickle cell disease. In: Holcomb III GW, Murphy JP, Ostlie DJ, editors. Ashcraft’s pediatric surgery. 5th ed. Philadelphia: Elsevier-Inc; 2010. p. 61-73.

Published
2015-06-30
How to Cite
1.
Milano L, Agustriani N, Rochadi R. Predictors of mortality in newborns with esophageal atresia: a 6-year study in a single institution. PI [Internet]. 30Jun.2015 [cited 22Nov.2024];55(3):131-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/37
Issue
Vol 55 No 3 (2015): May 2015
Section
Articles

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Received 2015-12-02
Accepted 2015-12-02
Published 2015-06-30