S. F. Rosati1, D. Parrish1, J. Haynes2, R. Maarouf1, C. Oiticica2, P. Lange2, D. Lanning2 1Virginia Commonwealth University,Department Of General Surgery,Richmond, VA, USA 2Virginia Commonwealth University,Division Of Pediatric Surgery,Richmond, VA, USA
Introduction:
Children born with congenital anomalies in low-income countries often face a multitude of challenges. Access to pediatric surgical services is limited due to a lack of medical facilities, an adequate transportation system, and a lack of trained surgeons, anesthesiologists, and nurses, all of which leads to a high mortality rate. This is a report of a 5-year collaborative effort between the World Pediatric Project (WPP), the Children’s Hospital of Richmond (CHoR) at Virginia Commonwealth University, and multiple organizations within the country of Belize to provide care for infants born with esophageal atresia (EA).
Methods:
After IRB approval, we reviewed medical records of children with EA treated in conjunction with the World Pediatric Project, which is a nonprofit organization that provides tertiary surgical care to children in Central America and the Caribbean. From 2009-2014, neonatologists and pediatric surgeons at our institution have collaborated with the WPP to care for infants born in Belize with EA. Six infants with EA (five also with an associated tracheoesophageal fistula) were transferred to our institution for surgical repair.
Results:
A total of six infants, two boys and four girls, have been transferred to our institution for operative correction of their EA. After the first patient was transferred to our institution, multiple opportunities for improving the process were identified. A protocol was created to help diagnose infants with EA, outline initial management, and facilitate obtaining travel documents. At the time of transfer, their ages ranged from 2 weeks to 2 months old. All six of the patients had gastrostomy tubes placed in Belize prior to transfer for decompression of their stomach and placement of a venous catheter for TPN after arrival. Of the five infants with TEF, two underwent open repair and three had a thoracoscopic repair. The infant with a pure atresia underwent thoracoscopic converted to open repair. There were no peri- or post-operative complications. All six infants were orally fed post–operatively and were transferred back to Belize where they are thriving. Pediatric surgeons from CHoR see them annually.
Conclusion:
Caring for infants born with congenital anomalies, specifically EA, can be challenging requiring the cooperation of a variety of specialties, including pediatric surgeons, neonatologists, pediatricians, and nutritionists. These challenges become even more complex with infants born in low-income countries. This report demonstrates how newborns with EA±TEF in a developing country can be successfully transferred to the US, receive medical and surgical care, and return to their country. While this endeavor is challenging, the process can be facilitated by having a protocol in place, a well-organized local nonprofit organization, and a hospital that is committed to providing international care to children.