1887
6 The Anbar 2nd International Medical Conference (AIMCO 2022)
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Many advances have been made in managing neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF). This resulted in a progressive decrease in mortality as a result of improved neonatal intensive care and neonatal mechanical ventilation; however, this is not the case in developing countries.

We aimed to evaluate the efficacy of postoperative ventilation in neonates with EA/TEF in Iraq as a developing country.

It is a prospective study for all neonates with EA and/or TEF admitted to the pediatric intensive care unit (PICU) in Alkhansaa Teaching Hospital between December 2012 to December 2014. Forty operated neonates were randomly divided into two groups according to the record number of presentations (even = G1, odd = G2): Twenty patients (group l) had been assigned to be post-operatively on a ventilator as a routine protocol. While group 2 planned to be extubated in the theater. We evaluated the complications and mortality rates in two groups.

For 24 months, 40 neonates with EA/TEF were admitted to PICU; Thirty-two were operated on within 24 hours of life. There were no significant differences between the two groups regarding fetal maturity (p-value 0.490), gender, and weight. The mean period for mechanical ventilation was four days. Six neonates had tube mal-positioning complications, leading to lung collapse, hypoxia, and pneumonia (p-value 0.250). Anastomotic leaks occur in 10 neonates (five in each group) (p-value 0.642), which sometimes leads to sepsis (p-value 0.347). Trachea-malacia was recorded after weaning in 5 intubated patients (p-value 0.078). The mortality rate in G1 was 35%, while in group 2 was 25% (p-value 0.366).

Although the study’s sample is small, it is recommended to avoid mechanical ventilation in the postoperative care of neonates with EA and/or TEF.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2022.aimco.15
2022-12-22
2023-02-09
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2022/6/jemtac.2022.aimco.15.html?itemId=/content/journals/10.5339/jemtac.2022.aimco.15&mimeType=html&fmt=ahah

References

  1. O’Neil JA Jr, Holcomb GW Jr, Neblett WW III. Recent experience with esophageal atresia. Ann Surg. 1982; 195:(6):739-45.
    [Google Scholar]
  2. Leven NL. Congenital atresia of the esophagus with tracheoesophageal fistula: report of successful extrapleural ligation of fistulous communication and cervical esophagostomy. J Thorac Surg. 1941; 10:(6):648-57.
    [Google Scholar]
  3. Randolph JG, Newman KD, Anderson KD. Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy. Ann Surg. 1989 May; 209:(5):526-30; discussion 530-1.
    [Google Scholar]
  4. Agarwala S, Bhatnagar V, Bajpai M, Gupta DK, Mitra DK. Factors contributing to poor results of treatment of esophageal atresia in developing countries. Pediatr Surg Int. 1996 Jun; 11:(5-6):312-5.
    [Google Scholar]
  5. Debo Adeyemi S. Management of Nigerian neonates with high risk esophageal atresia: early versus delayed repair. Pediatr Surg Int. 1989; 4:(2):76-9.
    [Google Scholar]
  6. Butterworth IV J, J.F., Mackey D.C., Wasnick J.D. Airway Management. In: Morgan & Mikhail’s clinical anesthesiology. 5th ed. McGraw-Hill; 2013.
    [Google Scholar]
  7. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R. Neonatal Anasthesia. In: Clinical anesthesia. 7th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2013. p. 1178–212.
    [Google Scholar]
  8. Butler MG, Hayes BG, Hathaway MM, Begleiter ML. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg. 2000 Oct; 91:(4):837-55.
    [Google Scholar]
  9. Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med. 2005 Jul; 31:(7):922-6.
    [Google Scholar]
  10. Cozzi DA, Capocaccia P, Roggini M, Matrunola M, Morini F, Cozzi F. Respiratory status of infants with esophageal atresia. Pediatr Surg Int. 2001 Mar; 17:(2-3):92-6.
    [Google Scholar]
  11. Malone PS, Kiely EM. Role of aortopexy in the management of primary tracheomalacia and tracheobronchomalacia. Arch Dis Child. 1990 Apr; 65:(4):438-40.
    [Google Scholar]
  12. Panitch HB, Keklikian EN, Motley RA, Wolfson MR, Schidlow DV. Effect of altering smooth muscle tone on maximal expiratory flows in patients with tracheomalacia. Pediatr Pulmonol. 1990; 9:(3):170-6.
    [Google Scholar]
  13. Kapadia FN, Bajan KB, Raje KV. Airway accidents in intubated intensive care unit patients: an epidemiological study. Crit Care Med. 2000 Mar; 28:(3):659-64.
    [Google Scholar]
  14. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5; 338:(6):347-54.
    [Google Scholar]
  15. Chatterjee A, Islam S, Divatia JV. Airway accidents in a surgical ICU. Indian Journal of Crit Care Med. 2004; 8:: 36-39.
    [Google Scholar]
  16. Complications of endotracheal intubation (2017) Anaesthesia UK: Complications of endotracheal intubation. Anaesthesia UK. Available at: https://www.frca.co.uk/article.aspx?articleid=100165 (Accessed: July 27, 2005).
    [Google Scholar]
  17. Seitz PA, Gravenstein N. Endobronchial rupture from endotracheal reintubation with an endotracheal tube guide. J Clin Anesth. 1989; 1:(3):214-7.
    [Google Scholar]
  18. Wagner DL, Gammage GW, Wong ML. Tracheal rupture following the insertion of a disposable double-lumen endotracheal tube. Anesthesiology. 1985 Dec; 63:(6):698-700.
    [Google Scholar]
  19. Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL. Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg. 1999 Jan; 34:(1):70-3; discussion 74.
    [Google Scholar]
  20. Al-Malki TA, Ibrahim AH. Esophageal atresia with tracheoesophageal fistula and early postoperative mortality. West Afr J Med. 2005 Oct-Dec; 24:(4):311-5.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2022.aimco.15
Loading
/content/journals/10.5339/jemtac.2022.aimco.15
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error