title: Esophageal Atresia: Improved Outcome in High-Risk Groups Revisited.
abstract: Objectives Improved survival in infants with esophageal atresia (EA) with a birth weight < 1,500 g or a major cardiac anomaly has been reported when compared with the original Spitz classification proposed in 1994. Aim We reviewed outcome data for infants born over the last decade in our institution to update previously reported survival statistics. Materials and Methods The records of all neonates (n = 200) with a diagnosis of EA managed in a single institution between 2001 and 2011 were reviewed and compared with data from the original Spitz study and the subsequent reported cohort from the same institution. Data were obtained on birth weight, presence of a major cardiac anomaly, and survival. Differences in survival were compared using the Yates-corrected chi-square test. Local ethical study approval was obtained. Results Infants born over the last decade had a comparable overall survival rate of 93% (186/200) versus 92.6% (174/188) in the previously reported cohort (1993-2004). We demonstrate an improved survival as compared to the Spitz cohort (87.6%, 326 /372, p = 0.06) and a statistically significant improvement in survival in Group II (p = 0.01). Within this group, 12/51 neonates had a birth weight < 1,500 g and 39/51 had major cardiac anomalies. Of interest, of the nine deaths in Group II, eight were in the subgroup with major cardiac anomalies. Conclusion The survival of neonates in Group II has significantly improved. Mortalities within this group were predominantly in the subgroup with major cardiac anomalies suggesting birth weight is of less significance than in previous years reflecting recent advances in neonatal care. We propose an updated prognostic classification that makes a distinction between cardiac and low-birth-weight infants.
authors.affiliation: Department of General Surgery, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Georgina
authors.initials: G
authors.lastname: Malakounides
authors.affiliation: Department of General Surgery, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Lyon
authors.affiliation: Department of General Surgery, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Cross
authors.affiliation: Department of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
authors.affiliation: Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Drake
authors.affiliation: Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
authors.affiliation: Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Lewis
authors.initials: L
authors.lastname: Spitz
authors.affiliation: Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Joe
authors.initials: J
authors.lastname: Curry
mesh_terms: D000015:Abnormalities, Multiple; D001724:Birth Weight; D002423:Cause of Death; D016009:Chi-Square Distribution; D004933:Esophageal Atresia / Q000145:classification / Q000150:complications / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology