BAPS-CASS - A population-based national study of surgical outcomes of infants born with oesophageal atresia
The aim of this project was to describe the incidence, management and outcomes of neonates with oesophageal atresia (OA) in the UK. OA is a congenital discontinuity in the oesophagus, often combined with a communication to the airways, and is often found in association with other congenital anomalies. Five subtypes of OA are described, but no national or population-based survey has been conducted previously to assess the incidence of each sub-type, success of antenatal diagnosis, national variation in management and outcomes. This prospective, descriptive study used the routine monthly mailing of the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS) to identify cases. Over the one year of the study, 151 infants with OA were identified, of whom the majority ( 83%) had oesophageal atresia with lower pouch tracheo-oesophageal fistula (Type C, Gross Classification). Overall, management was highly variable. Feeding via trans-anastomotic tube was started at a median of 3 days after anastomosis (range 0-17) and full TAT feeding established by a median of 6 days (range 2-86). Oral feeding was started at a median of 8 days (range 1-90) after surgery and established by a median of 10 days (range 3-127). Four infants died (case fatality 2.6%, 95%CI 0.7-6.6). These findings provide a benchmark of the current management of children with OA in the UK. This information is important for patient counselling, to highlight areas that require further research and to establish a gold-standard of practice.