ABSTRACT
Waterston’s seminal paper describing the influence of pulmonary disease, birth weight and associated congenital anomalies on outcome of infants treated for EA,2
provided a historical basis for comparison of subsequent outcome-based classification systems. Advances in medical care have now rendered the Waterston classification outdated. Spitz et al. have described a simplified classification system for the modern era (Table 34.1), based on birth weight and the presence or absence of major congenital heart disease.18 A Montreal classification system places greater emphasis on preoperative ventilator dependence and associated major anomalies as survival determinants.22 Other studies continue to emphasize the negative influence of respiratory distress syndrome (RDS) and pneumonia on outcome,23 and the contribution of aspiration episodes and other respiratory morbidity to late death following repair of EA.24 The influence on outcome of factors directly related to the atresia has received little attention. In this category, ‘long-gap’ EA is associated
with significant morbidity,25 and probably increased mortality (although statistical confirmation is difficult because of the relative rarity of long-gap EA).
