Infants with esophageal atresia weighing under 3 pounds

In a consecutive series of 339 infants with esophageal atresia seen since 1953 first in Liverpool and subsequently in Zurich, 12 or 4% weighed under 3 lb (1360 g) at the time of operation. Four had severe additional malformations causing death in the immediate postoperative period. Before 1957, all the infants weighing under 3 lb died, but of the six infants weighing between 2 and 3 lb (910 and 1360 g) operated upon by the author since that time, five have recovered. The only fatality was caused by the wrong choice of operation. This is discussed in detail. There appear to be no reasons why even the smallest infant with esophageal atresia should not survive, provided certain precautions in the preoperative, operative, and postoperative management are taken. These special methods are discussed in detail with special reference to transport, intensive therapy management, and operative technique. Follow-up examinations of these infants show that their subsequent development has been perfectly normal. On the basis of these figures it is suggested that today, associated malformations, especially of the heart and brain, are the only causes of postoperative mortality in esophageal atresia and that infants with even extremely low birth weights should survive.