Association of congenital anomalies with NICU course and early outcomes in neonates with esophageal atresia

Abstract

Aim: Esophageal atresia (EA) is a serious congenital malformation that requires early surgical intervention during the neonatal period and is frequently associated with additional structural anomalies. This study aimed to evaluate the impact of accompanying major congenital anomalies on the neonatal intensive care unit (NICU) course and early clinical outcomes in neonates with EA.

Materials and Methods: In this retrospective cohort study, neonates who were diagnosed with EA and managed in a tertiary-level NICU between January 2010 and December 2025 were reviewed. Patients were categorized into two groups based on the presence of major structural anomalies: those with EA without associated anomalies and those with EA with associated anomalies. Demographic and perinatal characteristics, surgical variables, and NICU-related parameters were analyzed. The primary outcome measures were the durations of mechanical ventilation and total parenteral nutrition (TPN), and the time to achieve full enteral feeding. Secondary outcomes included surgical complication rates and mortality.

Results: A total of 33 patients were included in the analysis. At least one major congenital anomaly was identified in 54.5% of the cases. Compared with infants with EA without associated anomalies, infants with EA and associated anomalies had significantly longer durations of mechanical ventilation (p = 0.049), postoperative total parenteral nutrition (p = 0.007), and time to achieve full enteral feeding (p = 0.009). Although the risk of short-term surgical complications was greater in patients with associated anomalies (OR: 4,71; 95% CI: 0.94–23.68), this finding did not reach statistical significance (p = 0.052). The mortality rates did not differ significantly between the groups (p = 0.392).

Conclusion: The presence of major concomitant congenital anomalies in neonates with EA is associated with increased postoperative morbidity and a prolonged NICU course. These findings underscore the importance of incorporating comorbidity burden into prognostic assessment and clinical management strategies in this high-risk population.