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New Trends in the Management of High-Risk Neonates

Donald W. Hight, MD; George McGowan, MD; Judith Smith, MD; Gerald Kent, MD; Frederick Alexander, MD

Arch Surg. 1987;122(4):421-423.

Abstract
• Once the reconstruction of esophageal atresia in infancy was reported, immediate repair became standard practice. High-risk infants carry an operative mortality of 30% to 80%. Staged surgical procedures were introduced to improve survival. "Delayed" reconstruction of esophageal atresia in selected cases has been reported to improve survival and eliminate staged surgical procedures. Between 1982 and 1986, 21 newborns were diagnosed as having esophageal atresia. Eight infants (32%) underwent "immediate" repair. In 13 infants repair was "delayed" for seven to 252 days. Four neonates with "pure" esophageal atresia underwent primary anastomosis, one was awaiting surgery, and another died in the postnatal period. As more high-risk infants survive the perinatal period, surgical reconstruction must be planned to maximize operative survival. The goal of delayed management of esophageal atresia is to restore intrinsic esophageal continuity.

(Arch Surg 1987;122:421-423)

Author Affiliations
From the Division of Pediatric Surgery, University of Connecticut Health Center, Farmington.

Footnotes
Accepted for publication Jan 7, 1987.

Read before the 67th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Sept 7, 1986.

Reprint requests to 85 Jefferson St, Hartford, CT 06106 (Dr Hight).

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