Charles Garabedian1, Rony Sfeir2, Carole Langlois3, Arnaud Bonnard4, Naziha Khen-Dunlop5, Thomas Gelas6, Laurent Michaud2, Fréderic Auber7, Fréderic Gottrand2, Véronique Houfflin-Debarge8. 1. Department of Obstetrics, Jeanne de Flandre Hospital, CHRU Lille, France. Electronic address: charles.garabedian@gmail.com. 2. Reference Center for Congenital Esophageal Abnormalities, Paris, France. 3. Department of Biostatistics, UDSL, University of Lille North of France, CHRU Lille, France. 4. Department of Pediatric Surgery, University Hospital Robert Debre, Paris, France. 5. Department of Pediatric Surgery, University Hospital Necker Enfants Malades, Paris, France. 6. Department of Pediatric Surgery, University Hospital of Lyon, Lyon, France. 7. Department of Pediatric Surgery, University Hospital Armand Trousseau, Paris, France. 8. Department of Obstetrics, Jeanne de Flandre Hospital, CHRU Lille, France.
Abstract
OBJECTIVE: Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA. STUDY DESIGN: We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year. RESULTS: Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
OBJECTIVE: Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA. STUDY DESIGN: We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year. RESULTS: Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
Authors: Yanqing Wu; E Albert Reece; Jianxiang Zhong; Daoyin Dong; Wei-Bin Shen; Christopher R Harman; Peixin Yang Journal: Am J Obstet Gynecol Date: 2016-03-31 Impact factor: 8.661