Abstract
The influence of birthweight, gestational age, and associated malformations on the survival rate was studied in cases of uncomplicated esophageal atresia. A collective of 66 infants (birthweight: 2856.9±506 g; gestational age: 38.9±1.5 weeks) was randomly selected from a registry we established on esophageal atresia, and which currently involves 311 infants. The inclusion criteria were: 1) birth data after January 1975, and neonatal intensive care, 2) primary end-to-end anastomosis with fistula closure to provide comparable surgical procedures, 3) no neonatal complications to exclude a possible influence on the mortality rate. The mortality rate of the whole collective was 7.6%. All 42 patients without associated malformations survived (birthweight: 2871.1±482 g; gestational age: 38.9±1.5 weeks). The 24 cases with associated malformations, however, had a mortality rate of 20.8%; the infants who died had mean birthweights of 2684±796 g, and gestational ages of 38.1±1 weeks. Thus associated congenital malformations turned out to have a significant influence on the mortality rate of cases with esophageal atresia (p=0.0017). In a further, separate analysis of the particular malformations, cardiac malformations were found to be the only ones that significantly influenced mortality (p=0.0001). The gestational age and weight at birth were not predictive of the lemortality rate in cases of uncomplicated esophageal atresia, whereas the association with cardiac malformations significantly reduced the chances of survival.
Zusammenfassung
In dieser Studie wurde der Einfluß des Geburtsgewichtes, des Gestationsalters und der assoziierten Mißbildungen auf die Überlebensrate von chirurgisch problemlosen Ösophagusatresiefällen untersucht. 66 Patienten (Geburtsgewicht: 2856.9±506 g, Gestationsalter: 38,9±1,5 Wochen) wurden nach folgenden Kriterien aus einem 312 Fälle umfassenden Register ausgewählt: 1. Geburtsdatum nach 1975 und intensivmedizinische Betreuung, 2. primäre End-zu-End-Anastomose mit Fistelverschluß als einheitliches Operationsverfahren, 3. keine neonatalen Komplikationen, um einen möglichen individuellen Einfluß auf die Letalität auszuschalten. Die Letalität betrug insgesamt 7,6%, wobei die 42 Fälle (Geburtsgewicht: 2871,1±482 g, Gestationsalter: 38,9±1,5 Wochen) ohne assoziierte Mißbildung überlebten, und 20,8% der 24 Fälle mit assoziierter Mißbildung verstarben. Das Geburtsgewicht der Verstorbenen war 2684±796 g und das Gestationsalter 38,8±1 Woche. Assoziierte Mißbildungen beeinflußten signifikant die Letalität dieser Ösophagusatresiefälle (p=0,0017). Bei weiterer detaillierter Prüfung der assoziierten Mißbildungen zeigten nur kardiale Malformationen einen signifikanten Einfluß auf die Letalität (p=0,0001). Sowohl das Gestationsalter als auch das Geburtsgewicht hatten keine Letalitätsrelevanz. Nur die assoziierten kardialen Mißbildungen mindern signifikant die Überlebenschance.
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Rokitansky, A., Kolankaya, A., Mayr, J. et al. Influence of associated malformations on survival rate of surgically uncomplicated esophageal atresia cases. Acta Chir Austriaca 25, 377–380 (1993). https://doi.org/10.1007/BF02602149
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DOI: https://doi.org/10.1007/BF02602149