Garabedian C, Sfeir R, Langlois C, Bonnard A, Khen-Dunlop N, Gelas T, Michaud L, Auber F, Piolat C, Lemelle J-L, Fouquet V, Habonima É, Becmeur F, Polimerol M-L, Breton A, Petit T, Podevin G, Lavrand F, Allal H, Lopez M, Elbaz F, Merrot T, Michel J-L, Buisson P, Sapin E, Delagausie P, Pelatan C, Gaudin J, Weil D, de Vries P, Jaby O, Lardy H, Aubert D, Borderon C, Fourcade L, Geiss S, Breaud J, Pouzac M, Echaieb A, Laplace C, Gottrand F, Houfflin-Debarge V
Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France.
Centre de référence des anomalies congénitales et des maladies de l'œsophage (CRACMO), 59000 Lille, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 Nov;44(9):848-54. doi: 10.1016/j.jgyn.2014.12.004. Epub 2015 Jan 17.
Evaluate neonatal management and outcome of neonates with either a prenatal or a post-natal diagnosis of EA type III.
Population-based study using data from the French National Register for EA from 2008 to 2010. We compared children with prenatal versus post-natal diagnosis in regards to prenatal, maternal and neonatal characteristics. We define a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1 year.
Four hundred and eight live births with EA type III were recorded with a prenatal diagnosis rate of 18.1%. Transfer after birth was lower in prenatal subset (32.4% versus 81.5%, P<0.001). Delay between birth and first intervention was not significantly different. Defect size (2cm vs 1.4cm, P<0.001), gastrostomy (21.6% versus 8.7%, P<0.001) and length in neonatal unit care were higher in prenatal subset (47.9 days versus 33.6 days, P<0.001). The composite variables were higher in prenatal diagnosis subset (38.7% vs 26.1%, P=0.044).
Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (longer gap). Even if it does not modify neonatal management and 1-year outcome, prenatal diagnosis allows antenatal parental counseling and avoids post-natal transfer.
评估产前或产后诊断为Ⅲ型食管闭锁（EA）的新生儿的管理及预后情况。
基于人群的研究，使用2008年至2010年法国国家食管闭锁登记处的数据。我们比较了产前诊断与产后诊断的儿童在产前、母亲及新生儿特征方面的情况。我们定义了一个包含发病率（吻合口食管漏、复发性瘘、狭窄）和1年死亡率的复合变量。
记录了408例Ⅲ型食管闭锁活产病例，产前诊断率为18.1%。产前诊断组出生后转诊率较低（32.4%对81.5%，P<0.001）。出生至首次干预的延迟无显著差异。产前诊断组的缺损大小（2厘米对1.4厘米，P<0.001）、胃造口术（21.6%对8.7%，P<0.001）及新生儿病房护理时长更高（47.9天对33.6天，P<0.001）。产前诊断组的复合变量更高（38.7%对26.1%，P=0.044）。
尽管食管闭锁的生存率很高，但产前检测出的病例与食管闭锁类型相关的发病率更高（间隙更长）。即使产前诊断不改变新生儿管理及1年预后，但它能在产前为家长提供咨询，并避免产后转诊。
