Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study

13 April 2021

Rony Sfeir, MD(1), Veronique Rousseau, MD(2), Arnaud Bonnard, PhD(3), Thomas Gelas, MD(4), Madeleine Aumar, MD(1), Nicoleta Panait, MD(5), Christian Piolat, PhD(6), Sabine Irtan, PhD(7), Virginie Fouquet, MD(8), Aurelie Lemandat, MD(9), Stephan De Napoli, MD(10), Edouard Habonimana, MD(11), Thierry Lamireau, PhD(12), Jean Louis Lemelle, PhD(13), Frederic El Baz, MD(14), Isabelle Talon, MD(15), Marie Laurence Polimerol, PhD(16), Hussein Allal, MD(17), Philippe Buisson, MD(18), Thierry Petit, MD(19), David Louis, MD(20), Hubert Lardy, PhD(21), Francoise Schmitt, MD(22), Guillaume Levard, PhD(23), Aurelien Scalabre, MD(24), Jean Luc Michel, MD(25), Olivier Jaby, MD(26), Cecile Pelatan, MD(27), Philine De Vries, MD(28), Corinne Borderon, MD(29), Laurent Fourcade, PhD(30), Jean Breaud, PhD(31), Myriam Pouzac, MD(32), Cecilia Tolg, MD(33), Yann Chaussy, MD(34), Sandy Jochault Ritz, MD(35), Christophe Laplace, MD(36), Elodie Drumez(37), and Frederic Gottrand, PhD(1)

(1) University of Lille, CHU Lille, INSERM U1286, Centre de reference des affections chroniques et malformatives de l’œsophage, Lille; (2) University Hospital of Necker Enfants Malades Paris; (3) University hospital of Robert Debre, Paris; (4) University Hospital of Lyon; (5) University Hospital of Marseille; (6) University Hospital of Grenoble; (7) University Hospital of Trousseau Paris; (8) University Hospital of Kremlin Bicetre, Paris; (9) University Hospital of Toulouse; (10) University Hospital of Nantes; (11) University Hospital of Rennes; (12) University Hospital Bordeaux; (13) University Hospital of Nancy; (14) University Hospital of Rouen; (15) University Hospital of Starsbourg; (16) University Hospital of Reims; (17) University Hospital of Montpellier; (18) University Hospital of Amiens; (19) University Hospital of Caen; (20) University Hospital of Dijon; (21) University Hospital of Tours; (22) University Hospital of Angers; (23) University Hospital of Poitiers; (24) University Hospital of Saint Etienne; (25) University Hospital of La Reunion; (26) General Hospital of Creteil; (27) General Hospital of Le Mans; (28) University Hospital of Brest; (29) University Hospital of Clermont Ferrand; (30) University Hospital of Limoges; (31) University Hospital of Nice; (32) General Hospital of Orleans; (33) University Hospital of Martinique; (34) University Hospital of Besancon; (35) General Hospital of Colmar; (36) University Hospital of Guadeloupe; (37) University of Lille, CHU Lille, Evaluation des technologies de sante et des pratiques medicales, Lille, France

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Objective

To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia
(EA)-tracheoesophageal fistula.

Study design

Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1 year of age as a proxy measure of morbidity, and complications during the first year of life.

Results

In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3 months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight (OR 0.52, 95%CI [0.38-0.72], P < .001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08–8.08], P = .034). LoS was associated with low birth weight (0.225 0.035, P < .001), associated malformations (0.082 0.118, P < .001), surgical difficulties (0.270 0.107, P < .001), and complications (0.535 0.099, P < .001) during the first year of life. Predictive factors for dependency on nutrition support at 1 year of age were complications before 1 year (OR 3.28 [1.23-8.76], P < .02) and initial hospital LoS (OR 1.96 [1.15-3.33], P < .01).

Conclusions

EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population. (J Pediatr 2021;-:1-7).

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