Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States.

Abstract

Although rare, esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) can lead to severe morbidity and mortality. A known complication of EA and/or TEF repair is vocal fold motion impairment (VFMI). To characterize the prevalence of VFMI among repaired EA and/or TEF at a national level and to identify factors associated with in-patient mortality and common clinical endpoints in this population (tracheostomy and gastrostomy tube dependence). This is a retrospective cohort study of inpatient neonate admissions with EA and/or TEF in the 2016 Kids' Inpatient Database (KID). Patients with a history of EA and/or TEF were identified with ICD-10 codes. VFMI prevalence was assessed by observed frequencies and percentages. Clinical endpoints included gastrostomy (G-)tube placement, tracheostomy status, and inpatient mortality. Potential predictors of these three primary outcomes included cardiac anomalies, airway disorders, chromosomal anomalies, surgery within 24h of admission, prematurity, and low birthweight (LBW). Chi-squared analysis was performed between each parameter and the primary outcomes. Significant associations (p-value<0.05) were further assessed with multivariate logistic regression. Of 1062 neonates with history of EA and/or TEF, 24 (2.3%) had VFMI. Among this population, 27 patients underwent tracheostomies and 63 required G-tubes. There was a significantly higher likelihood of tracheostomy in patients with VFMI compared to patients without (16.7% versus 2.2%; p<0.01). After multivariate analysis, birthweight less than 1.5kg (BW<1.5kg; OR=2.5, 95% CI: 1.03-6.10), extreme prematurity (OR=7.5, 95% CI: 2.00-28.07), cardiac anomalies (OR=1.8, 95% CI: 1.01-3.04) and chromosomal anomalies (OR=4.2, 95% CI: 2.39-7.44) were significantly associated with in-hospital mortality. Bronchopulmonary dysplasia (BPD; OR=4.7, 95% CI: 1.73-12.78) and BW<1.5kg (OR=2.4, 95% CI: 1.05-5.49) were significant predictors for G-tube status. For tracheostomy, BPD (OR=15.8, 95% CI: 4.70-52.83) and subglottic stenosis (SS, OR=11.2, 95% CI: 1.85-68.02) remained significant predictors after multivariate regression. The national prevalence of VFMI among neonates following EA and/or TEF repair was 2.3% and was associated with an increased likelihood of tracheostomy in the KID 2016. Significant predictors of in-hospital mortality were cardiac anomalies, chromosomal anomalies, extreme prematurity, and BW<1.5kg. BPD and SS were significant predictors of tracheostomy, and BPD and BW<1.5kg were significant predictors for G-tube requirements.