Modified prognostic criteria for oesophageal atresia and tracheo-oesophageal fistula

Abstract

Aim: With the advances in technology, the outcome of oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) has significantly changed. The aim of this study was to review the outcome of OA and TOF with respect to the various known prognostic criteria and to find out if there is a need for a further modification of the prevailing prognostic classification.

Methods: The case notes of 57 newborns with OA/TOF treated between 1996 and 2004 were reviewed retrospectively. Patient demographics, associated anomalies and management were studied. The outcome was analysed with respect to different published prognostic criteria (Spitz, Waterston, Bremen and Montreal).

Results: The results in this series show identical results for Waterston class A and B as well as for the Bremen "without complications" groups. Furthermore, there was no statistically significant difference between Spitz type I (survival 100 %) and type II (survival 92.8 %) (Fisher's exact test [p = 0.259], Pearson's chi-square [p = 0.088] and Mann-Whitney test [p = 0.091]). There was, however, a significant variation (Fisher's exact test) after combining the results for Spitz type I & II and comparing them to type III (p = 0.006). On the basis of these results, a further modified prognostic criteria for infants with OA/TOF is proposed. Group A would include infants with either a single poor prognostic risk factor (i.e., weight below 1.5 kg or a major cardiac anomaly) or isolated TOF/OA. According to this study, the prognosis for such infants should be excellent (survival = 98 %). The alternate group (B) would include infants affected by both negative risk factors and TOF/OA; such infants have a poor prognosis (survival = 33 %).

Conclusions: Survival for children with TOF/OA is not dependent on factors including birth weight, gestational age, pre/postoperative ventilation and a major cardiac anomaly taken independently. In the modified prognostic classification for OA/TOF, a low birth weight combined with cardiac malformations is associated with a poor prognosis. This alternate prognosticator offers benefits for appropriately advising parents of babies with such anomalies taking the current standards of care into consideration. It should also serve as a foundation stone for further prospective studies.