Perinatal factors influencing mortality and morbidity two years after esophageal atresia primary repair: a single center retrospective study

Abstract

Abstract Purpose: Long-term digestive, respiratory and neurological morbidity is significant in children who have undergone surgery for esophageal atresia (EA), especially after staged repair for long-gap EA. Risk factors for morbidity after primary repair (non-long-gap populations) have been less documented. We investigated perinatal factors associated with unfavourable outcome in children two years after a primary esophageal anastomosis. Methods: Single-center retrospective study, based on neonatal, surgical, and paediatric records of children born between December 1, 2002, and December 31, 2018, and followed up to age 2 years. The primary endpoint was unfavourable outcome at 2-years of age, defined by death or survival with severe respiratory, digestive, or neurologic morbidity. Univariate analyses followed by logistic regression analyses were performed to identify perinatal risk factors of unfavourable outcome among survivors at discharge. Results: 150 neonates were included (mean birth weight 2520±718 g, associated malformations 61%); at age two, 45 (30%) had one or more severe morbidities, 11 had died during the neonatal stay and 2 after discharge (8.7% deaths). In multivariate analyses in the 139 survivors at discharge, duration of ventilatory support (invasive and non-invasive) for more than 8 days (OR 3.74; CI95%[1.68-8.60]; p=0.001) and achievement of full oral feeding before hospital discharge (OR 0.20; CI95%[0.06-0.56]; p=0.003) were independently associated with adverse outcome after adjustment for sex, preterm birth, associated heart defect, any surgical complication and the occurrence of more than one nosocomial infections during the neonatal stay. Conclusions: Potentially modifiable neonatal factors are associated with 2-year unfavourable outcome after primary repair of EA.