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Retrospective case-control study of nutritional and respiratory status in children with type III esophageal atresia
Marie-Alix Chansou1, Rony Sfeir2, Arnaud Bonnard3
1UMPCP, University Hospital Centre, Angers, France.
Insights
Children with type III esophageal atresia (EA) face significant undernutrition risks, strongly linked to respiratory issues rather than surgical factors. Early identification of respiratory problems is crucial for managing nutritional status in these patients.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Respiratory Medicine
Background:
- Type III esophageal atresia (EA) presents unique challenges for affected children.
- Understanding long-term outcomes, particularly nutritional status, is essential for comprehensive care.
- The interplay between respiratory health and nutrition in this population requires further investigation.
Purpose of the Study:
- To assess the prevalence and risk factors of undernutrition in school-aged children with type III EA.
- To evaluate the impact of respiratory history and pulmonary function on nutritional status.
- To identify key determinants influencing undernutrition in this cohort.
Main Methods:
- A retrospective multicenter cohort study analyzed data from patients born between 2008-2013.
- Patients were categorized based on nutritional status (body mass index [BMI] z-score < -2 SD) at 6-9 years.
- Comparisons included baseline data, surgical history, and pulmonary function tests (spirometry).
Main Results:
- 9.4% of patients exhibited undernutrition, with higher rates of prematurity.
- Respiratory issues were significantly more prevalent: 75% showed restrictive spirometry patterns and 60% required pulmonary treatments.
- Multivariate analysis linked undernutrition to birth in a level 3 maternity, hernia/cryptorchidism surgery, restrictive lung syndrome, and pulmonary crisis treatment.
Conclusions:
- Respiratory status, not intestinal or esophageal surgeries, is significantly associated with nutritional outcomes in children with type III EA.
- Pulmonary function and history are critical factors in the undernutrition observed in this population.
- Targeted respiratory support may be vital for improving nutritional status in children with type III EA.
Objectives:
To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests at school-age.
Methods:
Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history, and outcomes of patients with or without undernutrition (body mass index [BMI] z-score < -2 SD) at the age of 6-9 years were compared.
Results:
Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 ± 0.4. At birth, 13 (65%) of them were preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs. 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p = 0.002), and 60% of them required pulmonary treatments (vs. 32%, p = 0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio [OR] = 6.0), hernia/cryptorchidism surgery (OR = 5.2), a restrictive syndrome (OR = 3.3) and pulmonary crisis treatment use (OR = 2.7) as associated with undernutrition.
Conclusions:
In contrast to intestinal and esophageal surgeries, respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA.
Clinical Trial Registration:
NCT04136795. (https://clinicaltrials.gov/study/NCT04136795?term=RestriMIS&rank=1).
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