Retrospective Cohort Analysis of Nutritional and Respiratory Status in Children with Type III Esophageal Atresia

ObjectivesTo evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests. MethodsRetrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history and outcomes of patients with or without undernutrition (body mass index (BMI) z-score < -2 SD) at the age of 6-9 years were compared. ResultsOf the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 +/- 0.4. At birth, 13 (65%) of them where preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p=0.002), and 60% of them required pulmonary treatments (vs 32%, p=0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio OR=6.0), hernia/cryptorchidism surgery (OR=5.2), a restrictive syndrome (OR=3.3) and pulmonary crisis treatment use (OR=2.7) as risk factors for undernutrition. ConclusionsIn contrast to intestinal and esophageal surgeries, the respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. Clinical trialNCT04136795. What is known- Undernutrition remains common in children operated on for esophageal atresia. - There are associations between prematurity and undernutrition in children with esophageal atresia. What is new- Undernutrition is associated with a restrictive ventilatory pattern and with the use of pulmonary crisis treatments in school-aged children with type III esophageal atresia; - On the contrary, in this population, associated malformative conditions including the digestive tract and esophageal surgeries secondary to esophageal repair do not predispose children to undernutrition.