Pathogenesis of apparent life-threatening events in infants with esophageal atresia

D. A. Cozzi, A. Zani, A. Conforti, P. Colarizi, C. Moretti, Francesco Cozzi

Research output: Contribution to journalArticlepeer-review


Many infants with a repaired esophageal atresia (EA) undergo fundoplication, aortopexy, orglossopexy because the mechanisms most responsible for airway obstruction and/or apparent life-threatening event (AO/ALTE) syndrome are considered to be gastroesophageal reflux (GER), tracheal compression (TC), or obstructive apnea, respectively. In the present study, we investigated whether these mechanisms are independent or interrelated. We developed a database of 120 consecutive patients with EA treated by the senior author between 1967-2002. We studied the clinical manifestations of patients with a cervical esophagostomy and/or blind lower esophageal stump, which ruled out TC and/or proximal esophageal GER as a mechanism for AO/ALTE. Of 25 neonates who underwent section/ligation of lower tracheo-esophageal fistula and/or feeding gastrostomy, 10 critically ill neonates died. Of 15 survivors, 9 infants had a feeding gastrostomy without an esophagostomy. Of these, 6 infants presented one or more episodes of AO, and 8 presented ALTE with or without AO. Subsequently, 5 of the 9 infants underwent an esophagostomy. Eventually, 11 infants had a feeding gastrostomy with an esophagostomy. Of the latter, 5 infants presented one or more episodes of AO, and 6 presented ALTE without AO. In conclusion, oral feeding, proximal esophageal GER, and TC are not essential for AO/ALTE syndrome to occur. They are probably factors which offer evidence of an underlying problem with control of upper airway patency.

Original languageEnglish
Pages (from-to)488-493
Number of pages6
JournalPediatric Pulmonology
Issue number5
Publication statusPublished - May 2006


  • Bradycardia
  • Cyanotic attacks
  • Dysautonomia
  • Hyperhidrosis
  • Obstructive apnea
  • Respiratory control
  • Tracheomalacia
  • Upper airway obstruction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine


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