Journal of pediatric surgery · 2025
Prenatal diagnosis of esophageal atresia - Still a challenge.
СтатьяНазвание и аннотация: Перевод в очереди
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Pollack Jessica C, Mathew Leny, Williams Clara, Hornyak Jake, Flohr Sabrina, Reynolds Tom, Hedrick Holly L, Oliver Edward R, Manfredi Michael A, Hamilton Thomas E, Dao Duy T
Аннотация
OBJECTIVE: We aimed to determine the performance of fetal ultrasound in prenatal detection of esophageal atresia/tracheoesophageal fistula (EA/TEF) and evaluate the impact of prenatal diagnosis on postnatal outcomes at a major quaternary care center.
METHODS: We conducted a retrospective review of patients who underwent prenatal screening for suspected congenital anomalies at our institution from 2013 to 2024 and included those with prenatal suspicion on ultrasound and/or postnatal diagnosis of EA/TEF (N = 70). We then performed a retrospective cohort analysis of all patients who underwent repair of EA/TEF at our institution, comparing outcomes between those with correct prenatal diagnosis (N = 28) and those with postnatal diagnosis only (N = 168).
RESULTS: The sensitivity of fetal ultrasound for prenatal diagnosis of EA/TEF was 48 %, with a positive predictive value (PPV) of 78 %. Sensitivity was 36 % in patients with type C and 100 % in patients with type A. Later gestational age (GA) at ultrasound and presence of fluid-filled esophageal pouch, under-distended/collapsed stomach, and polyhydramnios increased the odds of prenatal diagnosis among patients with type C EA/TEF. There was high concordance between fetal ultrasound and MRI in prenatal detection of EA/TEF. After adjusting for type of EA/TEF, GA at birth, and presence of major cardiac anomalies, there was no difference in age at initial operation, age at discharge, or rate of reoperation.
CONCLUSION: Fetal ultrasound has high PPV for prenatal diagnosis of EA/TEF and sensitivity is highly dependent on type of EA/TEF. There are no differences in outcomes between prenatally and postnatally diagnosed patients after adjusting for confounders.
METHODS: We conducted a retrospective review of patients who underwent prenatal screening for suspected congenital anomalies at our institution from 2013 to 2024 and included those with prenatal suspicion on ultrasound and/or postnatal diagnosis of EA/TEF (N = 70). We then performed a retrospective cohort analysis of all patients who underwent repair of EA/TEF at our institution, comparing outcomes between those with correct prenatal diagnosis (N = 28) and those with postnatal diagnosis only (N = 168).
RESULTS: The sensitivity of fetal ultrasound for prenatal diagnosis of EA/TEF was 48 %, with a positive predictive value (PPV) of 78 %. Sensitivity was 36 % in patients with type C and 100 % in patients with type A. Later gestational age (GA) at ultrasound and presence of fluid-filled esophageal pouch, under-distended/collapsed stomach, and polyhydramnios increased the odds of prenatal diagnosis among patients with type C EA/TEF. There was high concordance between fetal ultrasound and MRI in prenatal detection of EA/TEF. After adjusting for type of EA/TEF, GA at birth, and presence of major cardiac anomalies, there was no difference in age at initial operation, age at discharge, or rate of reoperation.
CONCLUSION: Fetal ultrasound has high PPV for prenatal diagnosis of EA/TEF and sensitivity is highly dependent on type of EA/TEF. There are no differences in outcomes between prenatally and postnatally diagnosed patients after adjusting for confounders.