Tracheoesophageal anomalies in Waterston C neonates: a 30-year perspective.

Two hundred and seventy-eight infants with congenital tracheoesophageal anomalies have been managed at the Columbus Children's Hospital since 1955. Fifty-four (20%) have been classified as high risk using Waterston's criteria of birth weight, associated anomalies, and pneumonitis. The infants have been divided into group I (n = 27, 1955 to 1969) and group II (n = 27, 1970 to 1984) to reflect the onset of mechanical ventilation and effective neonatal intensive care. The mean birth weight of infants in group II was significantly less than in group I (1,753 +/- 390 g v 1,950 +/- 505 g, P less than .05). The incidence of prematurity, measured by gestational age, has significantly increased with 9 of 27 (33%) infants in group II and 2 of 27 (7%) infants in group I less than 32 weeks gestation (P less than .05). The presence or severity of associated anomalies was not significantly different in groups I and II. Twenty patients in group I and 22 patients in group II underwent definitive management of their tracheoesophageal anomaly. Operative survival was 30% in group I and 74% in group II (P less than .05). Long-term survival was 15% in group I and 64% in group II (P less than .05). Early postoperative complications included aspiration pneumonitis, anastomotic leak, or stricture. The most frequent complications in long-term follow-up were recurrent pneumonias, which were observed in 9 of 16 children. Esophageal dysmotility or gastroesophageal reflux was documented in five of these children; four were managed successfully with positional or pharmacologic manipulations while one required an antireflux procedure. Thirty percent (5/16) are asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)