Preoperative Prediction of Survival in Oesophageal Atresia: A New Approach

A retrospective clinical study to identify survivors from nonsurvivors in oesophageal atresia (OA) with or without tracheo-osophageal fistula (TOF) was done in a private pediatric surgery centre. During the seven year study period from 1992 to 1999, 69 neonates with OA / TOF were managed. The overall survival rate was 52.1%. Severe bilateral pneumonia, severe associated anomalies (cardiac, renal etc), prematurity and hypothermia were associated with poor outcome (survival rate less than30%). Moderate pneumonia (unilateral) and age of presentation of more than 72 hrs were associated with survival rates of 35.3% and 38% respectively. Birth weight was not found to have significant impact on outcome. A new scoring system for preoperative prediction of survival is proposed. Factors having significant impact on outcome were assigned risk score of 1 to 3 on the basis of their degree of impact on outcome. Neonates with total risk score upto 2 (low risk category) had survival rate of 82.1 %, which dropped to 7.1 % in neonates with total risk score of 5 and above (very high risk category). Survival rate of 44.4 % was observed in category with score of 3 - 4 (high risk category). We found this scoring system more accurate in pre-operative identification of neonates at poor risk for survival in our context than traditional Waterston's classification, which appears to have lost its usefulness.

Keywords
Oesophageal atresia, tracheo-oesophageal fistula, prognostic classification