Short-term and Intermediate Outcomes for Newborns Managed With Esophageal Atresia at Kenyatta National Hospital

Abstract

Esophageal atresia is a congenital anomaly of the esophagus that results in an interrupted esophageal lumen. Esophageal atresia may be associated with or without a fistulous connection with the trachea. The lack of esophageal patency prevents normal swallowing and leads to pooling of secretions in the upper esophageal pouch which may subsequently be aspirated. Patients typically present within a few hours of life with mouth frothing, chocking and cyanotic episodes on attempts to feed and respiratory distress. Diagnosis is made by failed attempt at advancing a nasogastric tube which is confirmed by imaging to end or coil in the upper esophageal pouch. Definitive management involves surgery, with division of the tracheoesophageal fistula and anastomosis of the proximal and distal esophageal ends. Esophageal atresia is often associated with various congenital anomalies that impact on outcomes. There is need to analyze outcomes of surgical management for patients with esophageal atresia in order to optimize their care. Study Objective To determine the short-term and intermediate outcomes for patients managed with esophageal atresia and tracheoesophageal fistula at Kenyatta National Hospital. Methodology Retrospective cross-sectional study was used. Consecutive sampling was used to recruit study participants. Records of neonates managed at Kenyatta National Hospital with Esophageal Atresia from January 2014 to December 2023 who fit the inclusion criteria were retrieved. Data on demographics, clinical presentation, surgical management, complications and outcomes was extracted. The statistical software for social sciences version 26.0 was used to enter, code, and analyze the acquired data (SPSS 26.0). Continuous data was analyzed using means and standard deviations, whereas categorical data was analyzed using frequencies and percentages. The T test was be used to compare continuous variables, while the chi square or Fischer's exact test was used to compare categorical variables. The threshold for statistical significance was set at a p value of 0.05. Results The study included 118 neonates diagnosed with esophageal atresia, with an equal distribution between male and female patients, ratio 1:1. Majority of the new-born patients were of gestation 37.0 weeks or more (62.7%), were of birth weight of 2000g or more (86.4%), had admission weight more than2000g (79.7)and had preoperative feeding (71.2%).There were patients who had one or more of the congenital anomalies, of which the top most was cardiac (18.6%). The 6 anomalies mentioned as others were: Congenital hypertrophic pyloric stenosis (n=1), Down syndrome (n=1), Trisomy 18 (n=2), and Duedenal atresia (n=2). ������������������������������������������������������������������������������������������������������������������������������������������������ xii Only 76 of the 118 patients (64.4%) had undergone surgery and thoracotomy was the approach for all. There were a few patients with long gap atresia (11.8%), and 1 patient that had legthening procedure (1.3%). Intraoperative complications was observed on a few of the patients (15.8%).Majority of the patients had duration of between 1 to 7 days (69.7%) of mechanical ventilation. There had no vocal cord paralysis and only a few had lung collapse (15.8%).(21.1%) of the patients were reintubated.There were few patients that had anastomic leak (7.9%), and reoperation (2.6%). Duration of hospital stay was above 2 weeks for more than half of the patients (54.2%). Sepsis was observed in also more than half of the patients (57.9%). Only a few of the patients were discharged alive (28.0%), in-hospital mortality being 72%. The majority of repairs done were primary (96.1%). Few of the patients had anastomotic stricture (6.6%). Recurrent fistula was observed in only one patient (1.3%). Conclusion Neonates with EA at Kenyatta National Hospital experience significant postoperative morbidity, including high rates of sepsis and re-intubation. Comprehensive preoperative evaluation, meticulous surgical technique, and multidisciplinary postoperative management are essential to optimize outcomes in this population.