Feeding jejunostomy in neonates with complicated esophageal atresia: A retrospective descriptive single-center study

Anastomotic leak (AL) complicates 8%-29% of esophageal atresia (EA) repairs, precluding safe trans-anastomotic enteral feeding. Parenteral nutrition (PN) carries additional risks in neonates. Feeding jejunostomy (FJ) provides an alternative enteral route that bypasses the anastomosis, but data remain limited. This study describes the feasibility and safety outcomes of FJ in this clinical setting.

Single-center retrospective cohort study (2018-2023) of neonates undergoing EA/tracheoesophageal fistula (TEF) repair or transferred to this hospital for AL after EA repair.

Among 41 repairs, 7 AL occurred (17.1%), including 3 transfers with pre-existing AL after prolonged PN. Ten FJ procedures were performed (3 prophylactically) and were technically successful with no intraoperative or major postoperative complications. One patient (10%) had a minor FJ catheter occlusion managed by bedside catheter exchange without interruption of enteral nutrition. No major FJ-related complications occurred. Among 6 FJ-managed AL patients, the median time from FJ placement to radiologic leak closure was 9 days (range 6-14). Full enteral nutrition was achieved at a median of 3 days (range 2-4) in all FJ patients. No FJ patient developed new-onset cholestasis or central line-associated bloodstream infection (CLABSI). The 3 transfers (median PN 30 days; range 28-33) had pre-existing cholestasis and/or CLABSI at presentation; all improved after FJ placement and enteral feeding.

In this descriptive cohort, FJ was feasible and safe, enabling rapid full enteral nutrition in neonates with complicated EA, including those with AL. Despite the small sample size, these hypothesis-generating observations warrant prospective multicenter investigation in this high-risk population.