Preoperative management of children with esophageal atresia: current perspectives

Abstract

Esophageal atresia remains one of the most challenging congenital anomalies of the newborn. In recent years, because of the advances in prenatal diagnosis, neonatal critical care, and surgical procedures, overall outcomes have improved substantially, including for premature children. Nowadays, most of the research is focused on medium- and long-term morbidity, with particular reference to respiratory and gastroesophageal problems; the high frequency of late sequelae in esophageal atresia warrants regular and multidisciplinary checkups throughout adulthood. Surprisingly, there are few studies on the impact of prenatal diagnosis and there is continuing debate over the prenatal and preoperative management of these complex patients. In this review, we analyze the literature surrounding current knowledge on the management of newborns affected by esophageal atresia, focusing on prenatal management and preoperative assessment.

Keywords: esophageal atresia; prenatal diagnosis; tracheobronchoscopy; tracheoesophageal fistula; ultrasound scan.

Figure 1

Anatomical classification of esophageal atresia according to Gross. Notes: Anatomical classification of EA according to Gross. The primary types of congenital EA are EA with distal TEF (85%, Gross C), isolated EA without TEF (8%, Gross A), TEF without atresia or H-type TEF (4%, Gross E), EA with proximal TEF (3%, Gross B), and EA with proximal and distal TEF (<1%, Gross D). Abbreviations: EA, esophageal atresia; TEF, tracheoesophageal fistula.