الفهرس 
Incidence and EtiologyOnly 14 pages are availabe for public view
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Abstract
The present study targeted to evaluate the outcome of surgical correction of tracheoesophageal fistula (TEF) in neonates and determine the relation between outcome and different neonatal demographic and clinical data.
The study included 10 neonates diagnosed as having TEF using chest X-ray taken after pouring gastrographin through the inserted Ryle’s tube.
Studied neonates included 16 males and 14 females with a mean gestational age (GA) of 36.06+ 2.82 (32-40) weeks and mean birth weight (BW) of 2.29+ .5 kg (1500-3500) gm. Clinical examination defined 21 had congenital heart defects (CHD) for a frequency of 76.7% of total studied neonates and 60% among those had congenital anomalies.
Also, 14 neonates (56%) were found to have preoperative pneumonia; 9 had moderate and 5 had severe pneumonia. Neonatal categorization according Waterston Classification showed that 10 neonates were of group A, 14 neonates were of group B and 6 neonates were of group C.
All patients underwent TEF correction through right thoracotomy incision made in the 4th intercostal space. After tracheal repair, the repair
line was covered by a mideastinal pleural flap. Then, esophageal anastomosis was conducted in two layers and covered by a mideastinal pleural flap. A Ryle tube was inserted as a stent for anastomotic line and a chest drainage tube was inserted in the retropleural space.
All neonates passed smooth immediate postoperative (PO) course, but during follow-up period nine neonates (30%) developed PO leakage and four neonates (13.3%) developed PO stricture and four neonates (13.3%) developed postoperative mediastinitis a total postoperative complication rate of 56.7%.
Nineteen neonates (63.3%) completed their hospital stay uneventfully and were discharged alive (Survivors), while 11 neonates (36.7%) died during their hospital stay (Non- Survivors)
The frequency of males was significantly higher among survivors and survivors had significantly higher birth weight than non-survivors. However, survivors had non-significantly longer GA. The frequency of associated congenital anomalies was significantly higher, while the frequency of associated congenital cardiac anomalies and pneumonia was non- significantly higher among non-survivors compared to survivors. Moreover, the frequency of neonates among Waterston classes A and B and among was significantly higher among survivors.
Neonatal survival showed positive significant correlation with type of operation , higher grade on Waterston classification, while showed negative significant correlation with the presence of other congenital anomalies and severity of preoperative pneumonia.
CONCLUSION
The obtained results and review of literature allowed concluding the following:
1. Oesophygeal atresia is common congenital anomaly of the oesophagus.
2. Oesophygeal atresia is most commonly diagnosed during 1st 24hours of life, but it may be diagnosed ante-natal ,also it is not accepted nowadays to delay the diagnosis until the neonate starts to feed &develop aspiration pneumonitis
3. The associated congenital anomalies are present in more than 50% of cases.
4. A routine screening for other congenital anomalies is needed to be considered in each neonate diagnosed to have oesophygeal atresia
5. The congenital tracheoesophageal fistula (TOF) is usually associated with other congenital anomalies especially congenital cardiac anomalies.
6. Surgical repair of TOF through open thoracotomy is feasible and safe with uneventful immediate postoperative course.
7. Late PO complications included development of anastomotic leakage or stricture and account for 56.7% in frequency.
8. Follow-up survival rate is 63.3% and death is mostly attributed to complications of pre-exciting other congenital anomalies or development of chest infection or recurrent pneumonia.
9. Type of operation and high grade on Waterston classification are significant specific positive predictors for neonatal survival.
10. Presence of associated congenital anomalies and high severity of neonatal pneumonia are significant sensitive negative predictors for neonatal survival.