Early morbidity and perioperative course of neonates with esophageal atresia and tracheoesophageal fistula in a tertiary pediatric surgical center

Abstract

$\textbf {Background:}$ The management of infants (infs.) with esophageal atresia and tracheoesophageal fistula (EA $\pm$ TEF) is demanding and complex. The aim of this study was to evaluate early morbidity, the timing of surgery, and the results of surgery. $\textbf {Patients and Method:}$ We collected data of 30 consecutive infs. treated for EA $\pm$ TEF between 2006 and 2014. $\textbf {Results:}$ The median gestational age was 38 weeks (12 preterm), and the median Birth Weight (BW) was 2660 g (4 infs. had a BW < 1500 g). The median Apgar score at 10 minutes was 10 (range 7 - 10). The median umbilical artery pH (UapH) was 7.30. According to the Spitz classification, 19 infs. were group 1, 9 infs. Were group 2, and 2 infs. were group 3. Surgical repair was performed in 29 cases (25 EA; 4 isolated TEF). Once the infs. arrived at the pediatric surgery department, surgery was postponed overnight in 11 cases. The duration of postoperative (p.o.) mechanical ventilation was significantly shorter for operations performed on day 2 after delivery. Twenty-four infs. (83%) underwent surgery within 2 days after delivery, and 5 infs. had later surgery. Chest drains (p.o.) for pneumothorax were inserted in 6 infs. (21%), and gastrostomy was performed in 6 cases (21%). No re-thoracotomy was required. The median length of hospital stay was 17.5 days (6 to 120). The incidence of p.o. mortality was 1 in 29 (3%). $\textbf {Discussion:}$ The majority of the infs. presented growth retardation (indicated by low birth weight) and a stable immediate postnatal course. The data from this study support the concept of early but not emergent surgery for the majority of infs. with EA $\pm$ TEF. However, a remarkable rate of perioperative morbidity must be taken into account. $\textbf {Conclusion:}$ Surgery for EA $pm$ TEF can be performed safely during the first postnatal days with exception of very unstable preterm infants