title: The diagnosis of fetal esophageal atresia and its implications on perinatal outcome.
abstract: The current diagnostic accuracy and perinatal outcome of fetuses with esophageal atresia (EA) continues to be debated. In this review, we report on our experience at a tertiary care fetal center with the prenatal ultrasound diagnosis of EA. Enrollment criteria included a small/absent stomach bubble with a normal or elevated amniotic fluid index between 2005 and 2013. Perinatal outcomes were analyzed and compared to postnatally diagnosed EA cases. Of the 22 fetuses evaluated, polyhydramnios occurred in 73%. Three (14%) died in utero or shortly after birth, but none had EA. In the presence of an absent/small stomach and polyhydramnios, the positive predictive value for EA was 67%. In fetal EA cases confirmed postnatally (group 1, n = 11), there were no differences in gestational age, birthweight, or mortality when compared to postnatally diagnosed infants (group 2, n = 59). Group 1 was associated with long-gap EA, need for esophageal replacement, and increased hospital length of stay. When taken in context with the current literature, we conclude that ultrasound findings suggestive of EA continue to be associated with a relatively high rate of false positives. However, among postnatally confirmed cases, there is an increased risk for long-gap EA and prolonged hospitalization.
authors: Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 E. Hospital Drive, SPC 4211, Ann Arbor, MI, 48109, USA, shaunkun@umich.edu.
authors: Shaun M
authors: SM
authors: Kunisaki
authors: Steven W
authors: SW
authors: Bruch
authors: Ronald B
authors: RB
authors: Hirschl
authors: George B
authors: GB
authors: Mychaliska
authors: Marjorie C
authors: MC
authors: Treadwell
authors: Arnold G
authors: AG
authors: Coran
mesh_terms: D000328:Adult; D001724:Birth Weight; D015897:Comorbidity; D004933:Esophageal Atresia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D004947:Esophagus / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008824:Michigan / Q000453:epidemiology; D006831:Polyhydramnios / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*