PEDIATRICS Vol. 54 No. 5 November 1974, pp. 558-564
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Esophageal Atresia and Tracheoesophageal Fistula: Supportive Measures That Affect Survival

C. Everett Koop M.D., Sc.D.1, Louise Schnaufer M.D.1, and A. Michael Broennle M.D.1

1 Departments of Surgery and Anesthesia, Children's Hospital of Philadelphia, and the Harrison Department of Surgical Research, University of Pennsylvania, Philadelphia

The survival of infants with esophageal atresia with or without tracheoesophageal fistula has been analyzed over a 24-year period divided into three eras of five years each depending upon the quality of intensive care available and the most recent nine years' experience.

Early diagnosis and skillful transportation to definitive surgical care are essential. Diagnosis by x-ray with a coiled catheter in the upper esophageal pouch without the use of radiopaque material is beneficially reflected in a decreased incidence of pneumonia and a reduced mortality. The skills of anesthesia carried over into close supervision of respiratory care postoperatively have further increased the salvage rate of these infants.

As surgical technical problems have been overcome, the percentage of deaths due to associated major anomalies and pneumonia and/or sepsis has increased. Invasive techniques for diagnosis, for monitoring, and for treatment do not seem to be responsible for the sepsis.

In the most recent experience with 134 patients over nine years the overall survival was 66%; full-term infants had a 70% survival while the survival rate for prematures was 52%. In full-term infants without pneumonia and without a major associated congenital anomaly, the survival rate was 100% (44 patients).

Clearly the target for improvement in survival is the prevention of and the improvement in treatment of pneumonia and sepsis.

Submitted on April 8, 1974
Accepted on May 29, 1974