Pathogenesis of apparent life-threatening events in infants with esophageal atresia

Pediatr Pulmonol. 2006 May;41(5):488-93. doi: 10.1002/ppul.20408.

Abstract

Many infants with a repaired esophageal atresia (EA) undergo fundoplication, aortopexy, or glossopexy because the mechanisms most responsible for airway obstruction and/or apparent life-threatening event (AO/ALTE) syndrome are considered to be gastroesophageal reflux (GER), tracheal compression (TC), or obstructive apnea, respectively. In the present study, we investigated whether these mechanisms are independent or interrelated. We developed a database of 120 consecutive patients with EA treated by the senior author between 1967-2002. We studied the clinical manifestations of patients with a cervical esophagostomy and/or blind lower esophageal stump, which ruled out TC and/or proximal esophageal GER as a mechanism for AO/ALTE. Of 25 neonates who underwent section/ligation of lower tracheo-esophageal fistula and/or feeding gastrostomy, 10 critically ill neonates died. Of 15 survivors, 9 infants had a feeding gastrostomy without an esophagostomy. Of these, 6 infants presented one or more episodes of AO, and 8 presented ALTE with or without AO. Subsequently, 5 of the 9 infants underwent an esophagostomy. Eventually, 11 infants had a feeding gastrostomy with an esophagostomy. Of the latter, 5 infants presented one or more episodes of AO, and 6 presented ALTE without AO. In conclusion, oral feeding, proximal esophageal GER, and TC are not essential for AO/ALTE syndrome to occur. They are probably factors which offer evidence of an underlying problem with control of upper airway patency.

MeSH terms

  • Bradycardia / epidemiology
  • Comorbidity
  • Esophageal Atresia / etiology*
  • Esophageal Atresia / physiopathology
  • Esophageal Atresia / surgery*
  • Esophagostomy
  • Female
  • Humans
  • Hyperhidrosis / epidemiology
  • Infant, Newborn
  • Polyhydramnios / epidemiology
  • Pregnancy
  • Respiratory Tract Infections / epidemiology
  • Tracheal Diseases / epidemiology