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Updated: Mar 21, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental assessment at 24 months in infants with esophageal atresia: A prospective cohort study
Julia Tagmouti1, Manon Midavaine1, Victor Sartorius1,2
1Department of Neonatology and CRMR CRACMO, APHP, Necker-Enfants Malades University Hospital, Paris, France.
Insights
Most infants surgically treated for esophageal atresia (EA) show normal 24-month neurodevelopment. However, some experience delays, particularly in communication and social skills, highlighting the need for early screening and follow-up.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Neonatology
Background:
- Esophageal atresia (EA) is a congenital anomaly requiring surgical intervention.
- Neurodevelopmental outcomes in infants with EA are a growing concern.
- Early identification of developmental delays is crucial for timely intervention.
Purpose of the Study:
- To assess neurodevelopment at 24 months in infants with surgically treated EA using the Ages and Stages Questionnaire (ASQ).
- To identify perinatal and early-life factors linked to neurodevelopmental delay in this cohort.
- To evaluate specific skill domains affected in infants with EA.
Main Methods:
- Prospective enrollment of infants with EA into a multidisciplinary follow-up program.
- Utilized the ASQ to assess neurodevelopment, defining delay as scores ≤185 and reassuring development as >220.
- Analyzed clinical, surgical, and growth data to determine associated risk factors.
Main Results:
- 18% (13/74) of infants had significant neurodevelopmental delay (ASQ ≤185).
- Factors associated with lower ASQ scores included prematurity, prolonged hospitalization, multiple surgeries, and poor weight gain.
- Communication and social skills were most affected, with 80% in the delayed group scoring below -2 SD.
Conclusions:
- While most children with EA achieve normal development by 2 years, a significant minority face delays, especially in communication and social domains.
- Prolonged hospitalization and prematurity are key risk factors for neurodevelopmental delay.
- Targeted multidisciplinary follow-up and early screening are vital for optimizing outcomes in high-risk EA populations.
Objective:
To evaluate neurodevelopment at 24 months in infants surgically treated for esophageal atresia (EA), using the ages and stages questionnaire (ASQ), and identify perinatal and early-life factors associated with developmental delay.
Methods:
Infants with EA were prospectively enrolled in a structured multidisciplinary follow-up program. Total ASQ scores ≤185 were considered indicative of significant neurodevelopmental delay, while scores >220 reflected reassuring neurodevelopment. Five skill domains (communication, gross motor skills, fine motor skills, problem solving, and social skills) were also assessed. Clinical, surgical, and growth data were analyzed to identify associated risk factors.
Results:
Of the 74 infants included, 13 patients (18%) had an ASQ score ≤185. Lower ASQ scores were significantly associated with prematurity, prolonged hospitalization, multiple surgeries, poor weight gain at 1 and 2 years, and feeding disorders. After adjusting for gestational age and genetic anomalies, prolonged hospitalization remained associated with lower ASQ scores, and higher weight-for-age at 1 and 2 years with better ASQ scores. Communication and social skills were the most severely affected, with approximately 80% of infants in the ASQ ≤ 185 group scoring below -2 standard deviations.
Conclusion:
Although most children with EA demonstrated normal development at 2 years, a minority experienced significant delays, especially in communication and social skills. Early screening and targeted multidisciplinary follow-up are essential to support optimal outcomes in this high-risk population.
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