Risk Factors of Early Mortality and Morbidity in Esophageal Atresia With Distal Tracheo-Esophageal Fistula: A Population-Based Cohort Study.

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, 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 length of stay was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight [odds ratio (OR) 0.52 (95% confidence interval (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]. Length of stay 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 length of stay [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.