Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Faculty of Medicine, Department of Development and Regeneration, KU Leuven, Belgium.
Pediatr Neonatol. 2019 Jun;60(3):261-269. doi: 10.1016/j.pedneo.2018.07.003. Epub 2018 Jul 21.
Esophageal atresia is a major congenital foregut anomaly. Affected patients often suffer from respiratory and gastro-intestinal morbidity. The objective of this study is to identify possible neonatal predictive factors contributing to a long-term complicated clinical course in patients after repair of esophageal atresia.
A total of 93 patients born between 1993 and 2013, with esophageal atresia and surviving the neonatal period were included in this retrospective study. A complicated clinical course was defined as the occurrence of ≥1 of these complications: severe gastro-esophageal reflux, esophageal stricture requiring dilatations, need for tube feeding for >100 days, severe tracheomalacia, severe chronic respiratory disease and death. We used linear models with a binomial distribution to determine risk factors for gastro-intestinal or respiratory complicated evolution and a backward stepwise elimination procedure to reduce models until only significant variables remained in the model. Multinomial logistic regression was used to assess risk factors for different evolutions of complication. Model parameter estimates were used to calculate odds ratios for significant risk factors.
Fifty-seven patients (61%) had a complicated clinical course in the first year of life and 47 (51%) had a complicated evolution during years 1-6. In the first year, prematurity was a significant factor for complicated gastro-intestinal (OR 2.84) and respiratory evolution (OR 2.93). After 1 year, gastro-intestinal morbidity in childhood was associated with VACTERL association (OR 12.2) and a complicated first year (OR 36.1). Respiratory morbidity was associated with congenital heart disease (OR 12.9) and a complicated first year (OR 86.9). Multinomial logistic regression showed that prematurity (p = 0.018) and VACTERL association (p = 0.003) were significant factors of complications.
Prematurity is an important predictive factor for a complicated clinical course in early life. A complicated first year often predicts a complicated clinical course in childhood. These risk factors may be helpful in counseling of parents in the neonatal period.
食管闭锁是一种主要的先天性前肠畸形。患病患者常患有呼吸道和胃肠道疾病。本研究的目的是确定可能的新生儿预测因素，这些因素可能导致食管闭锁修复后的患者长期出现复杂的临床病程。
本回顾性研究共纳入 1993 年至 2013 年间出生的 93 例食管闭锁并存活至新生儿期的患者。复杂的临床病程定义为出现以下至少 1 种并发症：严重胃食管反流、需要扩张的食管狭窄、需要管饲喂养 >100 天、严重气管软化、严重慢性呼吸道疾病和死亡。我们使用二项分布的线性模型来确定胃肠道或呼吸道复杂演变的危险因素，并使用向后逐步消除程序来减少模型，直到模型中仅保留显著变量。多变量逻辑回归用于评估不同并发症演变的危险因素。使用模型参数估计来计算显著危险因素的优势比。
57 例患者（61%）在出生后 1 年内出现复杂的临床病程，47 例患者（51%）在 1-6 年内出现复杂的病程演变。在 1 年内，早产是胃肠道和呼吸道复杂演变的显著因素（OR 2.84 和 OR 2.93）。1 年后，儿童期的胃肠道发病率与 VACTERL 协会有关（OR 12.2），且与复杂的 1 年病程有关（OR 36.1）。呼吸道发病率与先天性心脏病（OR 12.9）和复杂的 1 年病程有关（OR 86.9）。多变量逻辑回归显示，早产（p=0.018）和 VACTERL 协会（p=0.003）是并发症的显著因素。
早产是早期生活中复杂临床病程的重要预测因素。复杂的 1 年病程常常预示着儿童期的复杂临床病程。这些危险因素可能有助于新生儿期家长的咨询。
