Mortality and surgery-related complications in very low and extreme low birth weight infants treated for esophageal atresia: a multi-center cohort study

INTRODUCTION: Surgical esophageal atresia (EA) repair is a complex operation with high risk of perioperative complications. Infants born with very low or extreme low birth weight (VLBW or ELBW) might be even at higher risk for developing perioperative complications. However, studies about this specific patient group are scarce, resulting in a knowledge gap on the outcomes of these infants. This hampers identifying the optimal treatment strategy, but also good counselling of parents. The aim of this study was to evaluate the mortality and surgery-related complication rates of VLBW and ELBW infants with EA after surgical esophageal repair in a multi-center cohort. METHODS: A multi-center retrospective cohort study was performed in five academic hospitals in the Netherlands. Data was extracted from the medical record of patients born with EA and birthweight 1000-1500 grams (VLBW) or <1000 grams (ELBW) between 2000-2019. The main outcomes were overall mortality and specific surgery-related morbidity 90 days postoperative. Only descriptive analyses were performed. RESULTS: In total, 44 children were born with EA and VLBW/ELBW, of which 39 were included who underwent EA repair, 10 ELBW and 29 VLBW. Of the 39 infants, 25 had additional congenital anomalies. Six out of 29 VLBW infants and three out of 10 ELWB infants deceased. Complications occurred in 17 VLBW and two ELBW infants. Anastomotic stricture was the most frequent complications (VLBW n=12, ELBW n=1), others were anastomotic leakage (VLBW n=5, ELBW n=0), pneumothorax (VLBW n=5, ELBW n=0), surgical site infection (VLBW n=1, ELBW n=1) and recurrent fistula (VLWB n=0, ELBW n=1). CONCLUSION: Mortality and surgery-related complication rates in VLBW/ELBW infants after surgical EA repair in this large cohort are in line with previous studies. However, outcomes after surgical repair of EA are worse compared to infants born with a normal birthweight. This information is important to consider during parent counseling and multidisciplinary consultation.