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.
Cozzi
D A
DA
Pediatric Surgery Unit, University of Rome La Sapienza, Rome, Italy.
Zani
A
A
Conforti
A
A
Colarizi
P
P
Moretti
C
C
Cozzi
F
F
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