New prognostic classification and managements in infants with esophageal atresia

PurposeThe aim of this study was to investigate the risk factors for in hospital mortality in infants with esophageal atresia (EA) without critical chromosome abnormality disorders and develop a new prognostic classification to assess the influence of external risk factors on the prognosis of EA, which could provide more effective treatment strategies in clinical practice.MethodsA retrospective chart review of all consecutive patients between January 1994 and December 2017, which included 65 EA infants who were admitted to Shizuoka Children's Hospital, was conducted. Based on multivariate analysis data and ROC analysis, the discrimination of the new prognostic classification was quantified and compared with that of the Spitz classification using the area under the ROC curve (AUC).ResultsMultiple logistic regression analysis showed that birth weight of <1606g (adjusted OR, 13.16; 95% CI, 1.16-352.75), and complex cardiac anomalies (adjusted OR 22.39; 95% CI 2.45-569.14) were significant risk factors for death. We have created a new classification close to Spitz classification using the presence of complex cardiac anomalies and birth weight. The mortality rates were 0% for class I (n=0/40), 7.1% for class II (n=1/14), 33.3% for class III (n=3/9), and 100% for class IV (n=2/2). The AUC of the new classification was better than that of the Spitz classification (0.939 vs 0.812, respectively; p=0.04).ConclusionNew prognostic classification can improve the stratification of EA patients and be a useful predictor of survival.