6144 How can you find what you’re not even looking for? Identifying which investigations are carried out for neonates with congenital tracheo-oesophageal fistula

Objectives Congenital tracheo-oesophageal fistula (TOF), with or without associated oesophageal atresia, is a rare condition. However, it is one that brings with it the potential for severe morbidity and mortality. Part of this is due to an established association with various other anomalies – for example, VACTERL association and CHARGE syndrome.¹–³ These may include – but are not limited to – cardiac, renal, and vertebral anomalies, and may require neonatal support, surgery or long-term medical follow-up.² Understandably, identifying such multi-system involvement is vital in order to aid prompt recognition, escalation and treatment.³ ⁴ It comes as a great surprise that there is no widely-accepted consensus on which investigations should be routinely done for a neonate with antenatally-diagnosed or postnatally-suspected TOF.⁵ Moreover, no data has been collected focussing solely upon UK-based practice. We aim to assess which investigations are routinely performed as a neonate in a Scottish tertiary paediatric centre, and whether there was any year-on-year variance in which investigations were done. Methods Using electronic hospital records, we have retrospectively analysed data from 83 patients with TOF, born from 2014–2022. These patients were identified by their registration to a multidisciplinary TOF follow-up clinic in a tertiary paediatric hospital in Glasgow, Scotland. Neonates identified who were documented to follow a palliative approach and neonates who died before investigations were performed were excluded. Results Our findings show that 99% of patients had a chest x-ray, while 95% had a preoperative echocardiogram. 92% and 86% had a renal ultrasound and preoperative bronchoscopy (rigid or flexible) respectively. Cranial ultrasounds, skeletal x-rays, abdominal ultrasounds and spinal ultrasounds were performed in a lower number. Furthermore, our results show that there was variation year-on-year for whether certain investigations were performed. Conclusion Some investigations should be universally recommended, where possible, for neonates with TOF. This includes chest x-rays (with NG tube in situ) to aid initial diagnosis, echocardiograms to assess preoperative cardiac function and plan operative approach, and preoperative bronchoscopy to characterise the TOF. However, other investigations may only be required in selected cases, reflecting how associated anomalies affect neonates with TOF to varying degrees. Here, a neonates' presentation should guide whether these investigations are performed. Through further research at a multi-centre level across the United Kingdom, this process should be formalised into a national guideline for the investigative approach to the neonate with TOF. References Singh, et al. Effect of number of associated anomalies on outcome in oesophageal atresia with or without tracheoesophageal fistula patient. Afr J Paediatr Surg 2013 Oct-Dec. Hakalmaz, Tekant. Anorectal malformations and late-term problems. Turk Arch Paediatr 2023 Aug 16. Chittmittrapap, et al. Oesophageal atresia and associated anomalies. Arch Dis Child 1989 Mar. Beasley. Influence of associated anomalies on the management of oesophageal atresia. Indian J Paediatr 1996 Nov-Dec. Morini, et al. Diagnostic workup of neonates with esophageal atresia: results from the EUPSA esophageal atresia registry. Front Paediatr 2020 Aug 25.