Analysis of Factors Influencing Mortality and Morbidity in Neonates with Esophageal Atresia in a Tertiary Care Centre in a Developing Country

Esophageal atresia (EA) is a type of congenital anomaly caused by an abnormal embryological development of the esophagus, anatomically characterized by a congenital obstruction of the lumen of the esophagus or interruption in the continuity of the esophageal wall. The esophagus is divided into two blind pouches, an upper and lower, which may or may not communicate with the tracheobronchial tree, through a fistulous tract called tracheoesophageal fistula (TEF/TOF). It is a rare anomaly occurring in between 1 in 3000 and 1 in 4500 live births. To analyze the factors influencing mortality and morbidity in neonates with Esophageal Atresia in a tertiary care centre in a developing country. The hospital stay and progress of all neonates with esophageal anomalies admitted between July 2009 and Dec 2011 at the neonatal surgical unit, PGIMS, Rohtak, Haryana, India was analysed prospectively. Data extracted included age at admission, sex, gestational age, birth weight, place of delivery, history of feeding , associated congenital anomalies, respiratory status, type of esophageal atresia, gap between upper and lower pouch and postoperative complications. The survival was defined when the infant was discharged. Waterston prognostic criteria were used for survival. In this study, records of 174 neonates were analysed. The male to female ratio was 2.3:1. The mean gestational age was 37 weeks (32-42 weeks) and the mean birth weight was 2.3 kg ( 900 g to 4.0 kg). Majority of the babies were having history of feeding before being referred from peripheral health care centres including private nursing homes. The mean age at admission at our surgical unit was 2.7 days . The associated congenital anomalies were seen in 53% patients and the cardiac anomalies were the commonest (37%). The commonest type of anomaly was esophageal atresia with distal fistula (90%). Twenty two (13%) neonates could not be operated due to reasons which included parental refusal for surgery, multiple anomalies and babies too sick even for staged repair. The operative survival rate in this series was 65% and the overall survival was 57%. The factors responsible for high mortality in this series were: delayed diagnosis, poor antenatal as well as postnatal services, prematurity, low birth weight and early feeding leading to aspiration pneumonitis and sepsis. Moreover, lack of transportation facilities for sick neonates also added to the poor survival.