COVID-19 and Esophageal Atresia Version 2
1.
email of reporting clinician
2.
Center
3.
Country
4.
How the patient had a confirmation of SARS-CoV-2 infection
PCR
Rapid test
Other (considered positive after contact with an infected person)
5.
Age
6.
Weight (kg)
7.
Height (cm)
8.
Type of atresia
Type A
Type B
Type C
Type D
Type E
9.
Gender
Male
Female
10.
Associated malformation
Cardiac
Other
None
11.
Associated respiratory problem
Tracheomalacia
Asthma
Recurrent chest infections
Aspirations
Aortopexia
On inhaled steroids
12.
Associated digestive problems
GERD
PPI treatment
Anastomotic stricture < or = 3 dilatations
Anastomotic stricture > 3 dilatations
Eosinophilic esophagitis
Swallowed steroids
13.
Symptoms at presentation
Cough
Fever > 38 degrees
Vomiting
Diarrhea
Rhinitis
Dyspnea
Other (please describe)
14.
List all medications prior to SARS-CoV-2 infection
15.
White blood cells count (peak during infection)
16.
CRP (mg/L) (peak during infection)
17.
Ped ICU admission needed
Yes
No
18.
Number of days in ICU
19.
Results of Chest X-ray/CT-Scan
20.
Respiratory support at peak of COVID-19
None
Oxygen
High flow nasal canula
BIPAP
CPAP
Conventional mechanical ventlation
ECMO
21.
Number of days since onset of illness (days) to reach the peak of COVID-19
22.
Specific therapy directed to SARS-CoV-2
23.
Other organs affected
Liver
Kidney
Brain
Cardiac
24.
Outcome
No hospitalization
Admitted on the ward and discharged
Need of ICU
Death
Progression actuelle,
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