Postoperative care of patients with esophageal atresia operated in pediatric surgery clinic and the assessment of their life quality

ABSTRACT POSTOPERATIVE CARE OF PATIENTS WITH ESOPHAGEAL ATRESIA OPERATED IN PEDIATRIC SURGERY CLINIC AND THE ASSESSMENT OF THEIR LIFE QUALITY In this study, clinical information regarding a total of 57 patients who were operated in Fırat University Faculty of Medicine Pediatric Surgery Department between the years 1996-2011 and who were diagnosed with EA and TEF (Esophageal Atresia and Tracheo-Esophageal Fistula) and whose treatment and follow-up were done at the Pediatric Surgery Clinic of Fırat University Hospital was reviewed retrospectively. The patients' hospital records, the clinical findings of cases obtained through whose epicrises were examined, whether they were diagnosed or not, the patient's age and weight when he/she was brought to hospital, gestational age; place, type and date of delivery, atresia type, additional cases of abnormality, in which group the patient takes place in terms of Waterson risk group, the date and type of the applied surgery, early and late surgical complications, the development of cases in the assessment of late complications, present clinical complaints, reasons for morbidity and mortality, feeding state during postoperative processes, physical and psychological developmental situations were analyzed. The patient's gender, prematurity, the patients' weight and age when they were accepted to the hospital and atresia type, the existence of additional abnormality and post-operative early complication rates and mortality rates according to Waterson risk group were compared on SPSS statistics program using Chi-square test. Moreover, the intellectual development state of babies with esophageal atresia aged 0-6 was assessed using Ankara Development Scanning Inventory (ADSI) was used; and that of children aged 6-16 was assessed using the revised form of Weschsler Intelligence Scale for Children (WISC-R), (intelligence scale test for children). Of 57 patients operated in our clinic between the years 1996-2011, 36 were boys and 21 were girls. 8 patients were lost due to sepsis, 4 patients were lost due to pneumonia, 4 patients were lost due to labored breathing and 2 patients were lost due to anastomosis leakage. 50 patients were cases of esophageal atresia (EA) + distal tracheo-esophageal fistula (TEF). 6 patients were the case of isolated esophageal atresia (EA). 1 was the case of isolated tracheo-esophageal fistula (TEF). Of the patients who were lost, 13 were esophageal atresia (EA) + distal tracheo-esophageal fistula (TEF) and 5 were isolated esophageal atresia (EA). All the patients were pre-diagnosed. 21 patients were in Waterson A (low) risk group, 15 were in Waterson B (moderate) risk group and 21 were in Waterson C (high) risk group. Additional abnormality was observed in a total of 20 patients. Mortality rates were higher in patients with additional abnormalities. Of the total of 57 patients, intelligence developments of 24 patients at the 0-6 age group was suitable to normal calendar age and intelligence levels (IQ) of 15 patients at 6-16 age group were found as between 95-110. In conclusion, morbidity and mortality are high in patients with low birth weight, born as premature, taken to hospital late (after the baby is 2 days old), with additional abnormalities, having post-operative complications and in the Waterson C (high) risk group. The operation conducted on these patients, duration of hospital stay and the applied treatments did not have a negative impact on the intelligence development of the patients Keywords: Esophageal Atresia, Tracheo-Esophageal Fistula, Intelligence Level, Life Quality