title: Does continuous positive airway pressure for extubation in congenital tracheoesophageal fistula increase the risk of anastomotic leak? A retrospective cohort study.
abstract: OBJECTIVE
  Immediate post-operative care of tracheoesophageal fistula (TEF) and oesophageal atresia (EA) requires mechanical ventilation. Early extubation is preferred, but subsequent respiratory distress may warrant re-intubation. Continuous positive airway pressure (CPAP) is a well-established modality to prevent extubation failures in preterm infants. However, it is not favoured in TEF/EA, because of the theoretical risk of oesophageal anastomotic leak (AL). The aim of this study was to find out if post-extubation CPAP is associated with increased risk of AL.
  
  
  METHODS
  Retrospective cohort study (2007-2014).
  
  
  RESULTS
  Fifty-one infants underwent primary repair in the newborn period. Median age at surgery was 24 h (interquartile range: 12, 24). In the post-extubation period, 10 received CPAP, whereas 41 did not. The median post-operative day at the commencement of CPAP was 2.5 days (interquartile range: 1, 6 days). Zero out of 10 in the CPAP group and 4/41 in the 'no CPAP' group developed AL on routine post-operative contrast studies (P = 0.57). Zero out of 10 in the CPAP group and 1/41 in the 'no CPAP group' developed recurrence of TEF necessitating re-surgery (P = 1.00). The neonate with recurrent fistula also had coarctation of aorta and needed protracted hospitalisation of 6 months, mainly because of the recurrence of TEF.
  
  
  CONCLUSIONS
  The use of CPAP in the immediate post-extubation period after corrective surgery for TEF/EA appears to be safe and may not be associated with increased risk of AL or recurrence of the fistula. Information from other centres, surveys and large databases is needed to define the benefits and risks of use of CPAP in these infants.
authors.affiliation: Department of Neonatology, King Edward Memorial Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia.
authors.forename: Piyush S
authors.identifier: http://orcid.org/0000-0003-0293-6788
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Department of Paediatric Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia.
authors.forename: Parshotam
authors.initials: P
authors.lastname: Gera
authors.affiliation: Department of Paediatric Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Gollow
authors.affiliation: Department of Neonatology, King Edward Memorial Hospital and Princess Margaret Hospital, Perth, Western Australia, Australia.|Centre of Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Shripada C
authors.initials: SC
authors.lastname: Rao
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects* / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D000013:Congenital Abnormalities; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D014138:Tracheoesophageal Fistula / Q000628:therapy*
keywords: CPAP; anastomotic leak; oesophageal atresia; tracheoesophageal fistula