Nutritional status at age 1 year in patients born with esophageal atresia: A population-based, prospective cohort study

Abstract

ObjectiveDespite recent progress in caring for patients born with esophageal atresia (EA), undernutrition and stunting remain common. Our study objective was to assess nutritional status in the first year after birth with EA and to identify factors associated with growth failure.Study designWe conducted a population-based study of all infants born in France with EA between 2010 and 2016. Through the national EA register, we collected prenatal to 1 year follow-up data. We used body mass index and length-for-age ratio Z scores to define patients who were undernourished and stunted, respectively. Factors with P < 0.20 in univariate analyses were retained in a logistic regression model.ResultsAmong 1,154 patients born with EA, body mass index and length-for-age ratio Z scores at 1 year were available for about 61%. Among these, 15.2% were undernourished and 19% were stunted at the age of 1 year. There was no significant catch-up between ages 6 months and 1 year. Patients born preterm (41%), small for gestational age (17%), or with associated abnormalities (55%) were at higher risk of undernutrition and stunting at age 1 year (P < 0.05). Neither EA type nor surgical treatment was associated with growth failure.ConclusionUndernutrition and stunting are common during the first year after birth in patients born with EA. These outcomes are significantly influenced by early factors, regardless of EA type or surgical management. Identifying high-risk patient groups with EA (i.e., those born preterm, small for gestational age, and/or with associated abnormalities) may guide early nutritional support strategies.

Sex-specific percentiles for bodyweight and height in children born with esophageal atresia: a registry-based analysis 2001–2021

“…While the median height is close to normal during the first 6 months of life, growth decelerates thereafter in the sense that height crosses percentiles between the ages of 6 and 15 months and develops along the tenth centile of the general population until the age of 6 years. This finding corroborated the results of the French EA Registry, showing no catch-up growth during the first year of life, but a harmonious growth retardation in some patients at the age of one year [ 5 ]. Feeding problems seem to have an immediate impact in body weight, but a delayed impact on body height in patients with EA.…”

“…Feeding difficulties are multifactorial, including esophageal, oropharyngeal and behavioural disorders [ 3 ]. Furthermore, esophageal atresia is associated with other congenital malformations in over half of all cases [ 4 , 5 ], such as cardiac abnormalities (28 to 42% [ 4 , 5 ]), which may influence growth and development [ 2 ]. Low birth weight is also frequently associated: 17 % of children with EA are born small for gestational age [ 5 ] and around 40% of children are born preterm [ 5 , 6 ].…”

“…Furthermore, esophageal atresia is associated with other congenital malformations in over half of all cases [ 4 , 5 ], such as cardiac abnormalities (28 to 42% [ 4 , 5 ]), which may influence growth and development [ 2 ]. Low birth weight is also frequently associated: 17 % of children with EA are born small for gestational age [ 5 ] and around 40% of children are born preterm [ 5 , 6 ]. A series of 287 patients reports a birthweight below 1500 g in 14% of newborns with EA [ 4 ].…”

“…While a reduced body weight and height was described in many studies [6][7][8][9], factors of comorbidity and prematurity have not been adequately considered [2]. A recent study of the National French EA Registry including more than 700 patients identified prematurity (odds-ratio 2.4), low birth weight (small for gestational age, odds-ratio 2) and other co-morbidity as risk factors for undernutrition or stunting at the age of one year, independent of the type of EA or technique of repair [5]. Bodyweight at discharge was shown to be predictive of bodyweightfor-age at the ages of one and three years.…”

The French Experience with a Population-Based Esophageal Atresia Registry (RENATO)

“…Neither EA type nor surgical treatment was associated with growth failure. 13,14 Gastroesophageal reflux disease was addressed in a study that identified several predictive factors for surgery within the first year of life. These factors included gastroesophageal reflux disease, low birth weight, poor nutrition, and surgical anastomosis difficulties.…”