OBJECTIVE:
Our study aimed at (1) evaluating neonatal management and outcome of neonates with either a prenatal or a postnatal diagnosis of EA (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA.
STUDY DESIGN:
Population-based study using data from the French National Register for infants with EA born from 2008 to 2010. We compared prenatal, maternal and neonatal characteristics amongst children with prenatal versus postnatal diagnosis and EA type I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1-year.
RESULTS:
469 live births with EA were recorded with a prenatal diagnosis rate of 24.3%. 82.2 % of EA type I were diagnosed prenatally compared to 17.9% of EA type III (p<0.001). Transfer after birth was lower in case of prenatal diagnosis (25.6 vs 82.5%, p < 0.001). The delay between birth and first intervention did not differ significantly amongst groups. The defect size was longer amongst the prenatal diagnosis group (2.61 vs 1.48 cm, p < 0.001). The composite variables were higher in prenatal diagnosis subset (44%vs 27.6%, p=0.003) and in EA type I than in type III (58.1% vs 28.3%, p < 0.001).
CONCLUSION:
Despite of the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (type I and/or long gap). Even though it does not modify neonatal management and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
Garabedian C1, Sfeir R2, Langlois C3, Bonnard A4, Khen-Dunlop N5, Gelas T6, Michaud L2, Auber F7, Gottrand F2, Houfflin-Debarge V8; French Network onEsophageal Atresia.
Am J Obstet Gynecol. 2014 Sep 26. pii: S0002-9378(14)00972-7. doi: 10.1016/j.ajog.2014.09.030
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The 7th international Conference on EA will be held in Istambul, Turkey, in 2025.