Long-Term Nutritional Status in Children Born With Esophageal Atresia.

Abstract

Previous studies have reported early undernutrition and growth delay in children born with esophageal atresia (EA). Our goal was to assess their long-term nutritional status. We longitudinally studied 204 children born with EA (91% with tracheoesophageal fistula) from birth to 16 years. Undernutrition (Z-score for body mass index [BMI] < -2 SD), and stunting (Z-score for height for age [HFA] < -2 SD) were evaluated. Risk factors were analyzed using regression models for interval-censored data. The mean Z-BMI and Z-HFA were lower in children with EA than the normal population from birth to age 16 years. At 12 years, the Z-BMI had increased closer to the normal range, but the Z-HFA still differed from the normal range. The cumulative incidence of wasting was 7% (95% CI, 5-12) among 1-year-olds with EA and 25% (95% CI, 19-31) of this population were undernourished at least once between ages 1 and 16 years. Undernutrition was significantly associated with congenital heart malformation (hazard ratio [HR] 2.7 [1.5-5.1]), prenatal EA diagnosis (HR 2.3 [1.2-4.3]), and use of proton pump inhibitors (PPIs) after 1 year of age (HR 3.6 [1.1-11.4]). Stunting was significantly associated with genetic anomalies (HR 6.0 [2.8-12.8]), multiple pregnancies (HR 2.4 [1.1-5.6]), gastrostomy (HR 2.3 [1.3-3.8]), and the use of PPI after 1 year (HR 7.8 [2.4-26.1]). Despite advances in care, children with EA remain at high risk of undernutrition and stunting from birth to age 16 years. Intensification of nutritional follow-up and early intervention are needed in high-risk patients.