Predictors of mortality after primary discharge from hospital in patients with esophageal atresia

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.Sharman P. Tan Tanny, Edward Fearon, Alisa Hawley, Jo-Anne Brooks, Assia Comella, John M. Hutson, Warwick J. Teague, Anastasia Pellicano and Sebastian K. Kin

Radio Pulsars

Almost 50 years after radio pulsars were discovered in 1967, our understanding of these objects remains incomplete. On the one hand, within a few years it became clear that neutron star rotation gives rise to the extremely stable sequence of radio pulses, that the kinetic energy of rotation provides the reservoir of energy, and that electromagnetic fields are the braking mechanism. On the other hand, no consensus regarding the mechanism of coherent radio emission or the conversion of electromagnetic energy to particle energy yet exists. In this review, we report on three aspects of pulsar structure that have seen recent progress: the self-consistent theory of the magnetosphere of an oblique magnetic rotator; the location, geometry, and optics of radio emission; and evolution of the angle between spin and magnetic axes. These allow us to take the next step in understanding the physical nature of the pulsar activity.Comment: Invited review for Space Science Review