Department of Obstetrics, Jeanne de Flandre Hospital, CHRU Lille, France.
Reference Center for Congenital Esophageal Abnormalities, Paris, France.
Am J Obstet Gynecol. 2015 Mar;212(3):340.e1-7. doi: 10.1016/j.ajog.2014.09.030. Epub 2014 Sep 28.
Our study aimed at (1) evaluating neonatal treatment and outcome of neonates with either a prenatal or a postnatal diagnosis of esophageal atresia (EA) and (2) analyzing the impact of prenatal diagnosis on outcome based on the type of EA.
We conducted a population-based study using data from the French National Register for infants with EA born from 2008-2010. We compared prenatal, maternal, and neonatal characteristics among children with prenatal vs postnatal diagnosis and EA types I and III. We defined a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and death at 1 year.
Four hundred sixty-nine live births with EA were recorded with a prenatal diagnosis rate of 24.3%; 82.2% of EA type I were diagnosed prenatally compared with 17.9% of EA type III (P < .001). Transfer after birth was lower in case of prenatal diagnosis (25.6% vs 82.5%; P < .001). The delay between birth and first intervention did not differ significantly among groups. The defect size was longer among the prenatal diagnosis group (2.61 vs 1.48 cm; P < .001). The composite variables were higher in prenatal diagnosis subset (44% vs 27.6%; P = .003) and in EA type I than in type III (58.1% vs 28.3%; P < .001).
Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity rate related to the EA type (type I and/or long gap). Even though it does not modify neonatal treatment and the 1-year outcome, prenatal diagnosis allows antenatal parental counselling and avoids postnatal transfers.
本研究旨在：（1）评估产前或产后诊断为食管闭锁（EA）的新生儿的治疗和结局；（2）根据 EA 类型分析产前诊断对结局的影响。
我们使用 2008 年至 2010 年法国出生的 EA 婴儿国家登记处的数据进行了一项基于人群的研究。我们比较了产前诊断与产后诊断、EA Ⅰ型和Ⅲ型患儿的产前、产妇和新生儿特征。我们定义了一个复合变量，包括发病率（吻合口食管漏、复发性瘘管、狭窄）和 1 岁时的死亡率。
共记录了 469 例 EA 活产儿，产前诊断率为 24.3%；82.2%的 EA Ⅰ型产前诊断，而 EA Ⅲ型仅为 17.9%（P＜0.001）。产前诊断组的出生后转院率较低（25.6%比 82.5%；P＜0.001）。出生与首次干预之间的时间间隔在各组之间无显著差异。产前诊断组的缺陷长度较长（2.61cm 比 1.48cm；P＜0.001）。产前诊断组的复合变量较高（44%比 27.6%；P=0.003），且 EA Ⅰ型高于 EA Ⅲ型（58.1%比 28.3%；P＜0.001）。
尽管 EA 的存活率很高，但产前发现的病例与 EA 类型（Ⅰ型和/或长间隙）相关的发病率更高。尽管产前诊断不会改变新生儿的治疗和 1 年结局，但它可以进行产前父母咨询，并避免产后转院。
