AI Article Synopsis
- This study analyzed mortality rates and associated factors in patients with esophageal atresia treated at The Royal Children's Hospital in Melbourne between 1980 and 2018.
- Out of 650 patients, 88 died, resulting in a 13.5% mortality rate; 75% of these deaths occurred before the patients were discharged from the hospital.
- Common causes of death included respiratory issues, associated syndromes like trisomy 18, and neurologic anomalies, with some deaths occurring years after discharge due to respiratory compromise and sudden unexplained deaths.
- The findings emphasize the importance of counseling for parents regarding the risks associated with esophageal atresia, highlighting that both preoperative and postoperative factors can impact mortality.
Article Abstract
Objective: To describe esophageal atresia mortality rates and their associations in our cohort.
Study Design: Patients with esophageal atresia, managed at The Royal Children's Hospital, Melbourne (1980-2018), who subsequently died, were retrospectively identified from the prospective Nate Myers Oesophageal Atresia database. Data collected included patient and maternal demographics, vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, renal anomalies, and limb defects (VACTERL) associations, mortality risk factors, and preoperative, operative, and postoperative findings. Mortality before discharge was defined as death during the initial admission.
Results: A total of 88 of the 650 patients (13.5%) died during the study period; mortality before discharge occurred in 66 of the 88 (75.0%); mortality after discharge occurred in 22 of the 88 (25.0%). Common causes of mortality before discharge were palliation for respiratory anomalies (15/66 [22.7%]), associated syndromes (11/66 [16.7%]), and neurologic anomalies (10/66 [15.2%]). The most common syndrome leading to palliation was trisomy 18 (7/66 [10.6%]). Causes of mortality after discharge had available documentation for 17 of 22 patients (77.3%). Common causes were respiratory compromise (6/17 [35.3%]), sudden unexplained deaths (6/17 [35.3%]), and Fanconi anemia (2/17 [11.8%]). Of the patients discharged from hospital, 22 of 584 (3.8%) subsequently died. There was no statistical difference in VACTERL association between mortality before discharge (31/61 [50.8%]) and mortality after discharge (11/20 [55.0%]), nor in incidence of twins between mortality before discharge (8/56 [14.3%]) and mortality after discharge (2/18 [11.1%]).
Conclusions: We identified predictors of mortality in patients with esophageal atresia in a large prospective cohort. Parents of children with esophageal atresia must be counselled appropriately as to the likelihood of death after discharge from hospital.
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| http://dx.doi.org/10.1016/j.jpeds.2019.12.031 | DOI Listing |
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