Objectives: To 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 at school-age.
Methods: Retrospective 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.
Results: Of 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 were 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 associated with undernutrition.
Conclusions: In contrast to intestinal and esophageal surgeries, respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA.
Clinical trial registration: NCT04136795. (https://clinicaltrials.gov/study/NCT04136795?term=RestriMIS&rank=1).
Keywords: restrictive ventilatory impairment; surgical long term outcomes; trachoesophageal repair; undernutrition.
© 2025 The Author(s). Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.