Sharman P Tan Tanny1,2,3, Sebastian K King1,2,3, Assia Comella1,3,4, Alisa Hawley1,3,5, Jo-Anne Brooks1,3,5, Rod W Hunt2,5,6, Bryn Jones2,7, Warwick J Teague8,9,10. 1. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia. 2. Department of Paediatrics, The University of Melbourne, Melbourne, Australia. 3. F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. 4. Department of Paediatrics, Monash University, Melbourne, Australia. 5. Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia. 6. Clinical Sciences, Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia. 7. Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia. 8. Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia. warwick.teague@rch.org.au. 9. Department of Paediatrics, The University of Melbourne, Melbourne, Australia. warwick.teague@rch.org.au. 10. F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. warwick.teague@rch.org.au.
Abstract
PURPOSE: Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography. METHODS: We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%. CONCLUSION: Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.
PURPOSE: Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography. METHODS: We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%. CONCLUSION: Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.
Authors: Augusto Zani; Simon Eaton; Michael E Hoellwarth; Prem Puri; Juan Tovar; Guenter Fasching; Pietro Bagolan; Marija Lukac; Rene Wijnen; Joachim F Kuebler; Giovanni Cecchetto; Risto Rintala; Agostino Pierro Journal: Eur J Pediatr Surg Date: 2013-08-09 Impact factor: 2.191
Authors: Ahmed Nasr; Patrick J McNamara; Luc Mertens; David Levin; Andrew James; Helen Holtby; Jacob C Langer Journal: J Pediatr Surg Date: 2010-05 Impact factor: 2.545