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PO-0676 Predictive Value Of Postnatal Nasogastric Tube And Chest/abdominal Xray For Antenatal Polyhydramnios And/or Small Stomach In The Diagnosis Of Oesophageal Atresia-tracheo-oesophageal Fistula
  1. J Egyepong1,
  2. D Bell2,
  3. T Busari3
  1. 1Neonatal Intensive Care Unit, Luton and Dunstable University Hospital, Luton, UK
  2. 2Medical School, University College London, London, UK
  3. 3Neonatal Intensive Care, Luton and Dunstable University Hospital, Luton, UK

Abstract

Introduction Oesophageal atresia (OA) ± trachea-oesophageal fistula (TOF) is a rare congenital anomaly which occurs in ~1/3500 total births.

Prenatal diagnosis of OA-TOF is desirable as it may improve patient outcome by optimising the pre- and postnatal management. Therefore, a high prenantal detection rate is desirable. Prenatal ultrasound is one of the modalities used in improving the diagnostic rate. Indirect or non-specific signs of suspected OA-TOF include polyhdramnios (10–20% of which are associated with fetal abnormalities, one of it being OA-TOF), absent/small stomach bubble, a blind ending upper oesophageal pouch and observation of fetal swallowing.

In our institution, all foetuses with Isolated polyhydramnios ± small/absent stomach have postnatal NGT insertion followed by xray if follow up scans remained the same.

Objectives To evaluate the clinical relevance of postnatal NGT insertion followed by xray for prenatal finding of isolated polyhydramnios ± absent/small stomach bubble in a cohort of newborn babies to assess for the diagnosis of OA-TOF.

Methods

  • Retrospective cohort review January2011-March2014 of all foetuses/neonates with suspected EA-TOF on prenatal ultrasound (isolated polyhydramnios [deepest pool >8 cm, Amniotic Fluid Index >95th percentile for gestational age and/or small/absent stomach bubble] or perinatally identified to have >1500 mls amniotic fluid and therefore needing postnatal NGT insertion+ Xrays pre-feed were identified.

  • Course and tip of NGT, stomach-bubble, vertebral anomalies or any other abnormalities detectable on Xray.

  • Time taken from birth to when the postnatal Xrays were taken was calculated (time to first feed).

  • Babies were also examined for clinical signs of OA-TOF or other abnormalities.

  • Clinical data on all OA-TOF cases that were diagnosed postnatally over the same 3 yr period.

  • Exclusion – above two features with other any other abnormalities on antenatal scans.

Results

  • Total deliveries over period= 17,200.

  • Total no. fulfilling criteria of isolated polyhydramnios ± small/absent stomach only = 48.

  • No. that resolved antenatally and therefore did not have NGT+Xray assessment postnatally = 12.

  • Total No. who had NGT+Xray assessment = 36.

  • No. without OA-TOF = 35.

  • No. diagnosed with OA-TOF = 1.

  • 7 cases of OA/TEF (1 had above 2 features); of which 3 did not have polyhydramnios ± absent/small stomach; 3 had multiple abnormalities including 2 with polyhydramnios.

  • Above two antenatal features had a Sensitivity =25%; Specificity =99.8%; positive predictive value=2.78% for diagnosis of OA-TOF.

  • Mean time for NGT+Xray (away from mothers and before their first) = 156 mins (range 81–332).

Conclusion

  • Isolated polyhydramnios ± absent/small stomach is very poor at predicting diagnosis of OA-TOF

  • Postnatal NGT+Xray are not indicated in isolated polyhydramnios ± small/absent stomach.

ConclusionSeparating these babies from their mothers is not warranted.

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