Pediatric Surgery International

, Volume 34, Issue 10, pp 1019–1026 | Cite as

New prognostic classification and managements in infants with esophageal atresia

  • Masaya YamotoEmail author
  • Akiyoshi Nomura
  • Koji Fukumoto
  • Toshiaki Takahashi
  • Kengo Nakaya
  • Akinori Sekioka
  • Yutaka Yamada
  • Naoto Urushihara
Original Article



The aim of this study was to investigate the risk factors for in hospital mortality in infants with esophageal atresia (EA) without critical chromosome abnormality disorders and develop a new prognostic classification to assess the influence of external risk factors on the prognosis of EA, which could provide more effective treatment strategies in clinical practice.


A retrospective chart review of all consecutive patients between January 1994 and December 2017, which included 65 EA infants who were admitted to Shizuoka Children’s Hospital, was conducted. Based on multivariate analysis data and ROC analysis, the discrimination of the new prognostic classification was quantified and compared with that of the Spitz classification using the area under the ROC curve (AUC).


Multiple logistic regression analysis showed that birth weight of < 1606 g (adjusted OR, 13.16; 95% CI, 1.16–352.75), and complex cardiac anomalies (adjusted OR 22.39; 95% CI 2.45–569.14) were significant risk factors for death. We have created a new classification close to Spitz classification using the presence of complex cardiac anomalies and birth weight. The mortality rates were 0% for class I (n = 0/40), 7.1% for class II (n = 1/14), 33.3% for class III (n = 3/9), and 100% for class IV (n = 2/2). The AUC of the new classification was better than that of the Spitz classification (0.939 vs 0.812, respectively; p = 0.04).


New prognostic classification can improve the stratification of EA patients and be a useful predictor of survival.


Esophageal atresia Cardiac anomaly Low birth weight 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

We received approval from the institutional ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Masaya Yamoto
    • 1
    Email author
  • Akiyoshi Nomura
    • 1
  • Koji Fukumoto
    • 1
  • Toshiaki Takahashi
    • 1
  • Kengo Nakaya
    • 1
  • Akinori Sekioka
    • 1
  • Yutaka Yamada
    • 1
  • Naoto Urushihara
    • 1
  1. 1.Department of Pediatric SurgeryShizuoka Children’s HospitalShizuokaJapan

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