Respiratory Outcomes in Children Born With Esophageal Atresia With or Without Tracheoesophageal Fistula: A Retrospective Longitudinal Cohort Study

Abstract

Background

The respiratory health of children born with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) can be compromised.

Purpose

We aimed to study how respiratory outcomes in EA/TEF cases change with increasing age and over time.

Methods

We performed a retrospective cohort study of children with EA/TEF treated in our centre from 1991 to 2022 and compared their respiratory outcomes to those of date-of-birth matched controls. Respiratory outcomes up to 2022 were identified using International Classification of Diseases codes (ICD-9). Odds ratios (OR), rate ratios (RaR) and Cox proportional hazard models were used to compare acute respiratory infections (ICD-9:460-466), asthma (ICD-9:493), bronchitis (ICD-9:490-491), influenza (ICD-9:487-488), and pneumonia (ICD-9:480-486) between cases and controls.

Results

A total of 95 cases and 945 controls were included. Cases were more likely to have asthma (OR = 2.32, 95%CI = 1.51,3.58) and pneumonia (OR = 5.94, 95%CI = 2.37,3.65) compared to controls. Cases had more episodes of acute respiratory tract infections and bronchitis (RaR = 1.45, 95%CI = 1.32,1.58; RaR = 13.3, 95%CI = 11.2,15.9, respectively). Influenza was unaffected by EA/TEF status. By late adolescence, new or recurrent episodes of respiratory disorders were uncommon, except for acute respiratory tract infections which continued to recur more often in cases than controls into adulthood. EA/TEF survivors born in recent years experienced fewer respiratory complaints than those born in the remote past.

Conclusion

Although the respiratory outcomes of children with EA/TEF were worse than controls, survivors can expect improved pulmonary health as they approach maturity, and respiratory health is improving for the contemporaneous EA/TEF population.

Level of Evidence

Prognostic, Level III.