Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States.

BACKGROUND: Although rare, esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) can lead to severe morbidity and mortality. A known complication of EA and/or TEF repair is vocal fold motion impairment (VFMI). OBJECTIVE: To characterize the prevalence of VFMI among repaired EA and/or TEF at a national level and to identify factors associated with in-patient mortality and common clinical endpoints in this population (tracheostomy and gastrostomy tube dependence). METHODS: This is a retrospective cohort study of inpatient neonate admissions with EA and/or TEF in the 2016 Kids' Inpatient Database (KID). Patients with a history of EA and/or TEF were identified with ICD-10 codes. VFMI prevalence was assessed by observed frequencies and percentages. Clinical endpoints included gastrostomy (G-)tube placement, tracheostomy status, and inpatient mortality. Potential predictors of these three primary outcomes included cardiac anomalies, airway disorders, chromosomal anomalies, surgery within 24 h of admission, prematurity, and low birthweight (LBW). Chi-squared analysis was performed between each parameter and the primary outcomes. Significant associations (p-value<0.05) were further assessed with multivariate logistic regression. RESULTS: Of 1062 neonates with history of EA and/or TEF, 24 (2.3%) had VFMI. Among this population, 27 patients underwent tracheostomies and 63 required G-tubes. There was a significantly higher likelihood of tracheostomy in patients with VFMI compared to patients without (16.7% versus 2.2%; p < 0.01). After multivariate analysis, birthweight less than 1.5 kg (BW < 1.5 kg; OR = 2.5, 95% CI: 1.03-6.10), extreme prematurity (OR = 7.5, 95% CI: 2.00-28.07), cardiac anomalies (OR = 1.8, 95% CI: 1.01-3.04) and chromosomal anomalies (OR = 4.2, 95% CI: 2.39-7.44) were significantly associated with in-hospital mortality. Bronchopulmonary dysplasia (BPD; OR = 4.7, 95% CI: 1.73-12.78) and BW < 1.5 kg (OR = 2.4, 95% CI: 1.05-5.49) were significant predictors for G-tube status. For tracheostomy, BPD (OR = 15.8, 95% CI: 4.70-52.83) and subglottic stenosis (SS, OR = 11.2, 95% CI: 1.85-68.02) remained significant predictors after multivariate regression. CONCLUSION: The national prevalence of VFMI among neonates following EA and/or TEF repair was 2.3% and was associated with an increased likelihood of tracheostomy in the KID 2016. Significant predictors of in-hospital mortality were cardiac anomalies, chromosomal anomalies, extreme prematurity, and BW < 1.5 kg. BPD and SS were significant predictors of tracheostomy, and BPD and BW < 1.5 kg were significant predictors for G-tube requirements.

Factors associated with invasive fungal sinusitis in patients with COVID-19: A systematic review and single-center case series.

Objective: Invasive fungal sinusitis (IFS) in patients with active or recent COVID-19 have been reported throughout the world. The primary purpose of the systematic review is to describe factors associated with IFS in patients with COVID-19. The goal of the case series was to also characterize these factors in addition to evaluating the incidence of IFS at our institution after the onset of the pandemic. Methods: A systematic review using the preferred reporting in systematic reviews and meta-analyses (PRISMA) framework identified publications of IFS cases associated with COVID-19 (IFSAC). Search terms were "COVID-19," "invasive," "fungal," and "sinusitis." IFS cases were evaluated for COVID-19 status, fungal etiology, comorbidities, treatment, and outcome. A case series of patients at our center with IFS between December 1, 2018 to March 31, 2020 ("pre-covid") and April 1, 2020 to August 1, 2021 ("post-covid") was also performed with the above parameters. Results: Fourteen studies totaling 206 cases of IFSAC were identified. Most cases came from India (140/206, 68.0%), followed by Egypt (62/206, 30.1%), and North America (4/206, 1.9%). Diabetes was the most common comorbidity (151/206, 73.3%). Recent or prolonged steroid use was noted in 65.0% of cases (134/206). In our series, five pre-covid and four post-covid cases were identified. One had recent COVID-19 infection. Acute myeloid leukemia was the most common pre-covid comorbidity (3/5, 60.0%). Diabetes was the most frequent post-covid comorbidity (2/4, 50.0%). Chronic steroid usage was noted in two pre-covid and one post-covid cases. Conclusion: Diabetes and steroid use are common factors in reported cases of IFSAC. IFS incidence in our case series did not change appreciably after the onset of the pandemic.Level of Evidence: 4.