Outcomes of multi-gestational pregnancies affected by esophageal atresia.
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1
The Hospital for Sick Children, Surgery/Pediatric Surgery, Canada
Corey Forster1,2, Eveline Lapidus-Krol1, Monping Chiang1, Vikki Scaini2, Beth Haliburton1, Paul Zamiara1, Peggy Marcon2, Aideen Moore3, Priscilla Chiu1
1 Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
2 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Canada
3 Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Introduction: The prognosis for multi-gestational vs. singleton pregnancies affected by esophageal atresia +/- tracheoesophageal fistula (EA/TEF) has not been reported.
Aim: To report the mortality and morbidity outcomes for singleton and multi-gestational EA/TEF patients.
Method: A single institution retrospective review of EA/TEF patients from 1999 to 2013 was performed including patient demographics, gestational age (GA), birth weight (BW), associated anomalies, EA/TEF type and gap length, complications and mortality with IRB approval (#1000032265).
Results: Of 236 (1%) of EA/TEF patients, 22 were from multi-gestational pregnancies; all were twin births (Table 1). Compared to singletons, EA/TEF twins were significantly more premature (p<0.01), had lower BW (p<0.01), were more frequently affected with duodenal atresia (p<0.05) and had higher mortality (p<0.05). In multi-variate analysis, EA/TEF twins with low BW (< 2000g) or GA <35 weeks (p<0.05) were significantly more likely to require gastrostomy tube for feeds at discharge (p<0.05). Compared to term births, the length of hospital stay for the premature infants was significantly longer (p<0.05).
Conclusion: EA/TEF infants of multi-gestational pregnancies have worse outcomes compared to singletons. Further review may provide greater insight into the underlying causes of the morbidities outlined here. Appropriate counseling to parents is needed to inform and assist families of potential morbid outcomes.
Table 1. Demographic and patient characteristics.
Singleton EA/TEF (n = 214) Multi-gestational EA/TEF (n = 22) p-value (Chi square test)
Male/Female 116/98 11/11 >0.05
GA (in days; mean, range) 260.97, 182 - 294 235.82, 161 - 276 <0.01
Birth weight in grams (mean, range) 2695.64,790 - 4390 1766.36, 540 - 2852 <0.01
VACTERL association (n, %) 122, 57.01% 12, 54.55% >0.05
Duodenal atresia (n, %) 12, 5.61% 4, 18.18% <0.05
Gastrostomy requirement (n, %) 71, 33.18% 9, 40.91% <0.01
References
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Brosens E, Ploeg M, van Bever Y, Koopmans AE, IJsselstijn H, Rottier RJ, et al.
Clinical and etiological heterogeneity in patients with tracheo-esophageal malformations and associated anomalies. Eur J Med Genet (2014) 57:440-52.
Keywords:
multi-gestational pregnancies,
Esophageal Neoplasms,
congenital anomalies,
VACTERL,
Morbidity,
Gastrostomy
Conference:
4th International Conference on Oesophageal Atresia / 15-16 September 2016 / Sydney Australia, Sydney, Australia, 15 Sep - 22 Nov, 2016.
Presentation Type:
Poster
Topic:
Registry and research collaboration in OA
Citation:
Chiu
PP
(2017). Outcomes of multi-gestational pregnancies affected by esophageal atresia..
Front. Pediatr.
Conference Abstract:
4th International Conference on Oesophageal Atresia / 15-16 September 2016 / Sydney Australia.
doi: 10.3389/conf.FPED.2017.01.00003
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Received:
15 Sep 2016;
Published Online:
11 Dec 2017.
*
Correspondence:
Dr. Priscilla P Chiu, The Hospital for Sick Children, Surgery/Pediatric Surgery, Toronto, Ontario, M5G 1X8, Canada, priscilla.chiu@sickkids.ca