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Staged surgical approach of neonates with esophageal atresia and tracheoesophageal fistula from low- and middle-income countries

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Abstract

Background

Neonates born in low- and middle-income countries (LMICs) with esophageal atresia (EA) and tracheoesophageal fistula (TEF) often do not have access to adequate surgical care. We have partnered with the non-profit organization World Pediatric Project (WPP) to facilitate care for such patients.

Methods

Our protocol included placement of a gastrostomy tube by local surgeons before definitive repair at the Children’s Hospital of Richmond at VCU (CHoR). The outcomes of WPP-sponsored patients with EA and TEF in this program (n = 9) were compared to patients born in the U.S. with the same condition at CHoR (n = 9).

Results

The baseline characteristics of the groups aside from the age at admission to CHoR and at day of surgery were comparable (0.5 ± 1.3 days vs. 15.3 ± 11.1 days, p < 0.0001; 1.1 ± 3.9 days vs. 37.3 ± 8.3 days, p < 0.0001, respectively). All patients received definitive repair without mortality; the average length of stay after surgery was lower in the WPP group. There were 4 surgical complications in the U.S. group and 1 in WPP group. All patients were weaned off of TPN and all WPP patients are now on a regular PO diet. Every WPP patient has been seen in follow-up in the U.S. and in their home country.

Conclusion

We provided successful multidisciplinary care for neonates with EA and TEF from LMICs with outcomes similar to the neonates with the same abnormality in the U.S. The partnership with WPP has been invaluable as it has provided essential support to identify and manage these patients.

Level of evidence

IV.

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Data availability

The datasets created for this study are available from the corresponding author upon request.

Abbreviations

CHoR:

Children’s Hospital of Richmond at VCU Health

EA:

Esophageal atresia

LMIC:

Low- and middle-income countries

OR:

Operating room

PO:

Per oral

TEF:

Tracheo-esophageal fistula

TPN:

Total parenteral nutrition

WPP:

World Pediatric Project

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Funding

No funding was received for conducting this study. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Virginia Commonwealth University Health, Richmond, VA, USA

    Hae Sung Kang, Samuel Kraus & David A. Lanning

  2. World Pediatric Project, Richmond, VA, USA

    Emily Robertson & David A. Lanning

  3. Division of Pediatric Surgery, Children’s Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA

    David A. Lanning

Authors
  1. Hae Sung Kang
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  2. Samuel Kraus
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  3. Emily Robertson
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  4. David A. Lanning
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Contributions

1. Study conception and design: Hae Sung Kang, Samuel Kraus, and David Lanning; 2. Data acquisition: Hae Sung Kang, Samuel Kraus, and Emily Robertson; 3. Analysis and data interpretation: Hae Sung Kang and David Lanning; 4. Drafting of the manuscript: Hae Sung Kang and David Lanning; 5. Critical revision: Hae Sung Kang, Samuel Kraus, Emily Robertson, and David Lanning

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Correspondence to David A. Lanning.

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Kang, H.S., Kraus, S., Robertson, E. et al. Staged surgical approach of neonates with esophageal atresia and tracheoesophageal fistula from low- and middle-income countries. Pediatr Surg Int 39, 67 (2023). https://doi.org/10.1007/s00383-022-05351-4

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