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.

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 where 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 risk factors for undernutrition.

Conclusions In contrast to intestinal and esophageal surgeries, the respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA.

Clinical trial NCT04136795.

What is known

- Undernutrition remains common in children operated on for esophageal atresia.

- There are associations between prematurity and undernutrition in children with esophageal atresia.

What is new

- Undernutrition is associated with a restrictive ventilatory pattern and with the use of pulmonary crisis treatments in school-aged children with type III esophageal atresia;

- On the contrary, in this population, associated malformative conditions including the digestive tract and esophageal surgeries secondary to esophageal repair do not predispose children to undernutrition.

The authors have declared no competing interest.

https://clinicaltrials.gov/study/NCT04136795?term=RestriMIS&rank=1

This study was funded by the University Hospital Centre of Angers (grant number 49RC19_0185_2), the non-profit sector associations "Institut de Recherche en Sante Respiratoire des Pays de la Loire (IRSR-PdL)" and the "Filiere des Maladies rares Abdomino-THOraciques (FIMATHO)".

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee of the University Hospital Center of Angers gave ethical approvel for this work

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Yes

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Yes

Conflicts of Interest and Source of Funding : Conflict of interest: None declared.

This study was financially supported by the University Hospital Centre of Angers (grant number 49RC19_0185_2), the non-profit sector associations “Institut de Recherche en Santé Respiratoire des Pays de la Loire (IRSR-PdL)” and the “Filière des Maladies rares Abdomino- THOraciques (FIMATHO)”.

All data produced in the present study are available upon reasonable request to the authors