title: Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia?
abstract: OBJECTIVE
  Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA.
  
  
  METHODS
  We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year.
  
  
  RESULTS
  Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001).
  
  
  CONCLUSIONS
  Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
authors.affiliation: Department of Obstetrics, Jeanne de Flandre Hospital, CHRU Lille, France. Electronic address: charles.garabedian@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Garabedian
authors.affiliation: Reference Center for Congenital Esophageal Abnormalities, Paris, France.
authors.forename: Rony
authors.initials: R
authors.lastname: Sfeir
authors.affiliation: Department of Biostatistics, UDSL, University of Lille North of France, CHRU Lille, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Langlois
authors.affiliation: Department of Pediatric Surgery, University Hospital Robert Debre, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
authors.affiliation: Department of Pediatric Surgery, University Hospital Necker Enfants Malades, Paris, France.
authors.forename: Naziha
authors.initials: N
authors.lastname: Khen-Dunlop
authors.affiliation: Department of Pediatric Surgery, University Hospital of Lyon, Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gelas
authors.affiliation: Reference Center for Congenital Esophageal Abnormalities, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.affiliation: Department of Pediatric Surgery, University Hospital Armand Trousseau, Paris, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Auber
authors.affiliation: Reference Center for Congenital Esophageal Abnormalities, Paris, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Gottrand
authors.affiliation: Department of Obstetrics, Jeanne de Flandre Hospital, CHRU Lille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin-Debarge
mesh_terms: D003131:Combined Modality Therapy; D004933:Esophageal Atresia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: associated anomaly; esophageal atresia; outcome; postnatal diagnosis; prenatal diagnosis