scholarly journals Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

2019 ◽  
Vol 9 (12) ◽  
pp. 383 ◽  
Author(s):  
Samuel S. Rudisill ◽  
Jue T. Wang ◽  
Camilo Jaimes ◽  
Chandler R. L. Mongerson ◽  
Anne R. Hansen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Esophageal Atresia ◽  
Brain Volume ◽  
Brain Mri ◽  
Full Term ◽  
Brain Growth ◽  
Term Infants ◽  
Long Gap ◽  
Long Gap Esophageal Atresia ◽  
The Impact

We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.

DOZ047.55: Midterm follow-up of long-gap esophageal atresia national cohort: study of feeding difficulties and morbidity

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
J Thomas ◽  
F Gottrand ◽  
G Levard ◽  
T Lamireau ◽  
L Michaud ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Conservative Management ◽  
National Database ◽  
National Study ◽  
Feeding Difficulties ◽  
Long Gap ◽  
Long Gap Esophageal Atresia ◽  
Special Assessment ◽  
The Impact

Abstract Introduction Long-gap esophageal atresia (LGEA) leads to multifactorial morbidity. The aim of this study is to analyze midterm gastrointestinal and respiratory morbidities with special assessment of feeding difficulties. Secondary goals were to determine risk factors of malnutrition and the impact of surgical techniques on morbidity. Methods We conducted a prospective observational national study. Using French national database, we reviewed medical charts of every patient treated for LGEA between 2008 and 2010 in France. Phone contact was proposed to assess orality disorders using Functional Oral Intake Scale (FOIS). Patients with complete data were included. We compared conservative management with esophageal replacement. Results We included 31 cases with a median age of follow-up of 9 years [7–10]. Median z-score for weight was −0.97 [−3.52–2.50], <to −2DS in eight patients (26%). Eleven patients (35%) had a medical treatment for gastroesophageal reflux (GER), 10 children (35%) had required at least one dilatation for stricture (median number of 2 [0–10]) and 17 patients (55%) complained of food impaction. Enteral feeding was required in three patients (10%). Orality disorders were present in 16 cases (52%). Ten children (30%) required a daily treatment for asthma and 3 (10%) had recurrent pulmonary infections. Low birth weight, preterm birth, congenital malformations, GER, dysphagia, abnormal FOIS and asthma were not associated with malnutrition. Conservative strategy was significantly associated with orality disorders (P = 0.04). Conclusion Midterm morbidity in LGEA concerns 80% of our population. Gastrointestinal morbidity includes mainly dysphagia, GER, and orality disorders. This study suggests that conservative management provides more orality disorders. Other studies are mandatory to confirm it.

DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Rasiewicz ◽  
K Świątek ◽  
S Gerus ◽  
D Patkowski
Keyword(s):  
Esophageal Atresia ◽  
Gold Standard ◽  
Distal Stump ◽  
Thoracic Vertebrae ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Proximal Stump ◽  
Long Gap Esophageal Atresia ◽  
Vertebral Bodies ◽  
Traction Group

Abstract Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

A pilot study of non-nutritive suck measures immediately pre- and post-frenotomy in full term infants with problematic feeding

2021 ◽  
Author(s):  
Rebecca R. Hill ◽  
Morgan Hines ◽  
Alaina Martens ◽  
Britt F. Pados ◽  
Emily Zimmerman
Keyword(s):  
Pilot Study ◽  
Full Term ◽  
Term Infants

DOZ047.36: Thoracoscopic esophageal internal axial traction for long- gap esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Juricic ◽  
N Panait ◽  
G Podevin ◽  
A Bonnard ◽  
P Lopez ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Operative Time ◽  
Median Number ◽  
Ethical Review ◽  
Multicenter Observational Study ◽  
Long Gap ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Axial Traction ◽  
Median Operative Time

Abstract Aim of the Study Long-gap esophageal atresia (LGEA) remains a surgical challenge. This study aimed to report the results of thoracoscopic esophageal axial internal traction in LGEA. Methods This multicenter observational study included retrospectively neonates who underwent primary thoracoscopic esophageal axial internal traction for LGEA between June 2017 and July 2018. LGEA was defined as the technical impossibility to perform a primary esophageal anastomosis. The Ethical Review Board of our institution approved the study. Main Results Eight neonates were included with a median gestational age at birth of 35 weeks [25; 37] and a median birth weight of 2266 g [890; 3800], 6 types I and 2 types II according to Ladd's classification. Initial median gap between 2 esophageal ends was 5 vertebral bodies [4.5; 7]. Internal traction was performed at a median age of 5 weeks of life [1; 17] with a median operative time of 87 minutes. Four patients required at least 2 internal traction procedures. After a mean traction time of 1.5 weeks [1; 13.5], esophageal anastomosis was successfully performed in 7 patients (5 thoracoscopies, 2 thoracotomies) with a median operative time of 165 minutes. One patient needed a colonic interposition. Five of these 7 patients required an esophageal endoscopic dilatation (median number: 4 [2; 6]). Median follow-up was 9.75 months [3; 16]. Conclusions Thoracoscopic esophageal axial internal traction for LGEA was a safe and feasible procedure that allowed an esophageal anastomosis in 7 of the 8 patients. Improvement of the procedure requires setting a common protocol concerning the timing of the first internal axial traction and the duration of traction before considering esophageal anastomosis.

scholarly journals Head circumference and anterior fontanel measurements in newborns

2012 ◽  
Vol 52 (3) ◽  
pp. 145 ◽  
Author(s):  
Rizal Agus Tiansyah ◽  
Irawan Mangunatmadja ◽  
Aman Pulungan
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Full Term ◽  
Brain Growth ◽  
Anterior Fontanel ◽  
Term Infants ◽  
Head Growth ◽  
Term Newborns ◽  
Male Subjects ◽  
The Brain

Background Head growth and anterior fontanel (AP) closureare passive processes in response to brain growth. The growthof the brain and skull starts in the third week of intrauterinegestation. roth processes run simultaneously as a part of integralgrowth, along 'With increasing gestational age, until post􀀿birth.Measurement of head circumference (He) and AF in newbornsis done to determine if the brain and skull grew normally duringthe intrauterine period.Objectives To investigate the differences in He and AF sizebetween preterm and full􀀿term infants, and the relationshipbetween gestational age (GA) and birth weight (BW) to Heand AF size.Methods This was a descriptive analytic study on preterm andfull􀀿term newborns. Measurement of HC and AF was conductedin three phases: just after birth, 1x24 and 2x24 hours of age.Analysis of HC and AF size differences between preterm and fullterm subjects was performed, as well as analysis of the correlationbetween GA and BW to HC and AF size.Results Two hundred fifty newborns completed the study. Therewere 180 full􀀿term and 70 preterm subjects. Median HC in full􀀿term and preterm male subjects were 34 cm (range 31􀀿37 cm)and 31 cm (27􀀿34 cm), respectively. Median HC in full􀀿termand preterm female subjects were 33 cm (31􀀿36 cm) and 32 cm(27􀀿3S.S cm), respectively. Median AF in full􀀿term and pretermmale subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.Scm), respectively, and in full􀀿term and preterm female subjectswere 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively.The HC of preterms were significantly lower than the fullterms(P<O.OOl), however the AF size was not different between these2 groups of newborns (P =0 .28). Correlation test between GA andBW to HC size revealed a positive correlation (r=0.620, P<O.OO 1and r=0.801, P<O.OOl, respectively), but not to AF size (r=􀀿 0.06,p􀁀 0.279 and F- 0.049, P􀁀0.44, respectively).Concl usions We found that the HC size of pre terms wassignificantly lower than thefullterms, but no significant differences in AF size between the two groups. GA and BW were associatedwith HC size, but not associated to AF size. [paediatr lndones.2012;52:145-51].

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