Conforti Andrea, Valfrè Laura, Scuglia Marianna, Trozzi Marilena, Meucci Duino, Sgrò Stefania, Bottero Sergio, Bagolan Pietro
Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Front Pediatr. 2018 Dec 18;6:401. doi: 10.3389/fped.2018.00401. eCollection 2018.
Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients. Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atresia and/or tracheoesophageal fistula (EA/TEF). Analysis of the impact of those airway anomalies in early post-operative outcomes was performed. This was a review of a prospectively collected database, including patients from January 2008 to December 2017. Patients enrolled in the present study were treated in a high-volume referral center. Present study included all newborn-infants consecutively treated for EA/TEF. All patients were evaluated by flexible laryngotracheoscopy performed under local anesthesia in spontaneous breathing. In case of airway malformation suspected during flexible endoscopy, a rigid endoscopy was performed to complete airway assessment. If post-operative respiratory symptoms (noisy breathing, respiratory difficulty, failure to extubate, or difficulty feeding) were noted, a second laryngotracheoscopy was performed. Primary study outcome was to evaluate the prevalence of LTA in EA/TEF infants, characterizing of LTA, and their impact on early post-operative outcomes. Those primary study outcomes were planned before data collection began. During the study period 207 patients with EA/TEF were treated. LTA had a period prevalence of 40.1% (83/207). Although no differences were recorded in terms of demographics and clinical presentation, LTA+ infants more frequently required tracheostomy (12/52, 23% vs. 0/124, 0%; 0.0001) and were at increased risk of death (12/83, 14% vs. 5/124, 4%; 0.009) in comparison with EA/TEF without LTA. Present data suggest a high prevalence of congenital LTA in patients affected by EA. Most of the abnormalities are congenital and a high proportion of patients with LTA require a tracheostomy. Mortality significantly correlates with the presence of LTA. Systematic airway endoscopic preoperative evaluation has to be pushed forward to minimize LTA-related morbidity and mortality.
喉气管异常的存在与食管闭锁患者的发病率增加和死亡率升高相关。确定在一个前瞻性收集的接受食管闭锁和/或气管食管瘘（EA/TEF）治疗的患者队列中喉气管异常（LTA）的患病率。对这些气道异常对术后早期结局的影响进行分析。这是对一个前瞻性收集的数据库的回顾，包括2008年1月至2017年12月的患者。本研究纳入的患者在一个高容量转诊中心接受治疗。本研究包括所有连续接受EA/TEF治疗的新生儿。所有患者均在局部麻醉下自主呼吸时通过可弯曲喉镜进行评估。如果在可弯曲内镜检查期间怀疑有气道畸形，则进行硬质内镜检查以完成气道评估。如果术后出现呼吸症状（呼吸嘈杂、呼吸困难、拔管失败或喂养困难），则进行第二次喉镜检查。主要研究结局是评估EA/TEF婴儿中LTA的患病率、LTA的特征及其对术后早期结局的影响。这些主要研究结局在数据收集开始前就已计划好。在研究期间，207例EA/TEF患者接受了治疗。LTA的期间患病率为40.1%（83/207）。尽管在人口统计学和临床表现方面未记录到差异，但与无LTA的EA/TEF相比，LTA+婴儿更频繁地需要气管切开术（12/52，23%对0/124，0%；P = 0.0001），且死亡风险增加（12/83，14%对5/124，4%；P = 0.009）。目前的数据表明，受EA影响的患者中先天性LTA的患病率很高。大多数异常是先天性的，且很大比例的LTA患者需要气管切开术。死亡率与LTA的存在显著相关。必须推进系统的气道内镜术前评估，以尽量减少与LTA相关的发病率和死亡率。
