Risk factors for 30-day mortality in neonates undergoing surgery for esophageal atresia

Despite advances in neonatal surgery and intensive care, esophageal atresia (EA) continues to carry a substantial risk of early postoperative mortality. The aim of this study was to investigate risk factors for 30-day mortality in neonates undergoing surgery for EA. Following approval by our institutional ethics committee, we conducted a retrospective study from January 1, 2010 to December 31, 2024, in a pediatric surgery department. All neonates (≤28 days) who underwent primary surgery for EA were included. During the 15-year study period, 113 neonates underwent surgery for EA, with 52.2% being male. Twenty-nine (25.7%) patients died within the first 30 postoperative days. The univariable analysis comparing non-survivors and survivors groups revealed that cardiac comorbidities, gestational age < 37 weeks, 5-min Apgar score ≤ 8, birth weight < 2500 g, and postoperative intubation time > 60 hours were potential risk factors for mortality. On multivariable logistic regression analysis, three factors emerged as independent predictive factors of 30-day mortality. These factors included birth weight < 2500 g (OR = 66.408; 95% CI: 5.887-749.164; P = 0.001), Apgar score (5 min) ≤ 8 (OR = 15.213; 95% CI: 3.444-67.197; P < 0.001), and cardiac comorbidities (OR = 9.768; 95% CI: 1.626-58.665; P = 0.013). Our findings may serve as a valuable tool for the early identification of neonates at increased risk of postoperative mortality, enabling timely risk stratification, optimized perioperative management, and improved decision-making in neonatal surgical care.