Management of Nigerian neonates with high-risk esophageal atresia: early versus delayed repair

Abstract

Twenty-two infants with high-risk esophageal atresia treated in Nigeria have been studied with the aim of determining: (1) when to carry out repair of the oesophagus; (2) whether it is better to carry out multiple or one-stage (primary) repairs; and (3) which thoracotomy approach is associated with a better chance of survival in these sick infants. The 7 survivors in the series were among the 12 infants who had early esophageal repair immediately following 24–48 h of medical treatment of their pneumonia. None of the 10 others in whom medical treatment was prolonged beyond 48 h or who had a staged procedure survived. There was no significant difference in the mortality of the 7 infants who had extrapleural thoracotomy from that of the 6 who had a transpleural approach (P<0.5). Pulmonary infection due to delayed diagnosis and administration of feedings was the commonest cause of death. Measures directed at early diagnosis in the newborn nursery before th baby is fed should drastically reduce the high mortality.