|Year : 2003 | Volume
| Issue : 1 | Page : 58-63
Waterston's Classification revisited : it relevance in developing countries.
B Eradi, KL Narasimhan, KLN Rao, A Grover, R Samujh, SK Chowdhary, JK. Mahajan
Department of Pediatric Surgery, PGIMER, Chandigarh 160 012, India
ABSTRACT: Objective Due to advances in neonatal care and operative technique, the Waterston's system of prognostic classification for esophageal atresia (EA) is no longer considered useful in the developed world. This study seeks to examine the preoperative factors related to prognosis in babies operated for EA under our conditions. Patients and Method This is a prospective study of 89 consecutive neonates treated for EA/tracheoesophageal fistula (TEF) between Jan 2000 and Dec 2000. No patient was excluded from the study. A detailed record of various factors affecting outcome was maintained. Statistical Analysis The X2 test and Student's test were used for comparative analysis with a significance level of p0.05. Stepwise forward regression analysis was also used, to obtain estimates of the risk of hospital death of infants with EA. Results Overall survival in babies with EA was only 48 percent while survival in patients undergoing primary esophageal anastomosis was 61 percent. The factors significantly affecting survival were pneumonia at presentation, birth weight, gestational age, preoperative sepsis and perinatal asphyxia. Maternal age, gravidity, age at presentation and attempted feeds before presentation did not significantly affect survival. Logistic regression analysis revealed pneumonia and birth weight to be the most important prognostic factors. However, Waterston's classification had significantly better correlation with survival than the above factors alone. Conclusion Waterston's stratification is valid and relevant as a prognostic indicator under our circumstances.
Department of Pediatric Surgery, PGIMER, Chandigarh 160 012
Source of Support: None, Conflict of Interest: None
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