Pathogenesis of apparent life-threatening events in infants with esophageal atresia.
Many infants with a repaired esophageal atresia (EA) undergo fundoplication, aortopexy, or glossopexy because the mechanisms most responsible for airway obstruction and/or apparent life-threatening event (AO/ALTE) syndrome are considered to be gastroesophageal reflux (GER), tracheal compression (TC), or obstructive apnea, respectively. In the present study, we investigated whether these mechanisms are independent or interrelated. We developed a database of 120 consecutive patients with EA treated by the senior author between 1967-2002. We studied the clinical manifestations of patients with a cervical esophagostomy and/or blind lower esophageal stump, which ruled out TC and/or proximal esophageal GER as a mechanism for AO/ALTE. Of 25 neonates who underwent section/ligation of lower tracheo-esophageal fistula and/or feeding gastrostomy, 10 critically ill neonates died. Of 15 survivors, 9 infants had a feeding gastrostomy without an esophagostomy. Of these, 6 infants presented one or more episodes of AO, and 8 presented ALTE with or without AO. Subsequently, 5 of the 9 infants underwent an esophagostomy. Eventually, 11 infants had a feeding gastrostomy with an esophagostomy. Of the latter, 5 infants presented one or more episodes of AO, and 6 presented ALTE without AO. In conclusion, oral feeding, proximal esophageal GER, and TC are not essential for AO/ALTE syndrome to occur. They are probably factors which offer evidence of an underlying problem with control of upper airway patency.
Pediatric Surgery Unit, University of Rome La Sapienza, Rome, Italy.
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Cozzi
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Zani
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Conforti
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Colarizi
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Moretti
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Cozzi
D001919:Bradycardia / Q000453:epidemiology; D015897:Comorbidity; D004933:Esophageal Atresia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D004946:Esophagostomy; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000453:epidemiology; D007231:Infant, Newborn; D006831:Polyhydramnios / Q000453:epidemiology; D011247:Pregnancy; D012141:Respiratory Tract Infections / Q000453:epidemiology; D014133:Tracheal Diseases / Q000453:epidemiology