Time to Death and Predictors Among Neonates with Esophageal Atresia in Ethiopia

Esophageal atresia is an upper gastrointestinal tract developmental abnormality in which the upper and lower esophagus do not connect. Esophageal atresia has a higher incidence of death in sub-Saharan Africa, ranging from 30% to 80%. In Ethiopia, infants with esophageal atresia had a higher mortality rate. The assessment of time to death and predictors of esophageal atresia can help to reduce newborn mortality.

This study was aimed to investigate the time to death and predictors of neonates with esophageal atresia admitted to Tikur Anbessa Specialized Hospital, Ethiopia.

An institutional-based retrospective follow-up study was conducted among 225 neonates diagnosed with esophageal atresia. The median survival time, Kaplan-Meier failure estimation curve, and Log rank test were computed. Bivariable and multivariable Cox regression hazards models were fitted to identify the predictors of time to death. Hazard ratio with a 95% confidence interval was calculated and p-values <0.05 were considered statistically significant.

In the study, the incidence density rate of neonates diagnosed with esophageal atresia was 5.5 (95% CI, 4.7-6.4) per 100-neonates day. The median time to death was 11 days (95% confidence interval (CI), 8.92-13.08). Birth weight <2500 g (adjusted hazard ratio (AHR)=1.49, 95% CI, 1.02 -2.21), having sepsis (AHR=1.67,95% CI, 1.15-2.44), being malnourished (AHR = 1.61, 95% CI, 1.03 -2.58), esophageal atretic neonates without surgery (AHR = 3.72, 95% CI, 1.34-10.38), diagnosis time at >48 hours of admission (AHR = 1.48, 95% CI, 1.01-2.15) and being dehydrated (AHR = 2.38, 95% CI, 1.63-3.46) were significant predictors of time to death among esophageal atretic neonates.

The findings in this study highlighted the necessity of early diagnosis, proper comorbidity treatment, and timely surgical intervention to reduce infant deaths due to esophageal atresia.