733 - Determinants of Time to Discharge in Patients with Type C, Esophageal Atresia/Tracheoesophageal Fistula (EA/TEF)

Occurring in ~1 per 4500 live births, esophageal atresia with tracheoesophageal Fistula (EA/TEF) most commonly manifests as "Type C," with a proximal esophageal pouch and distal TEF.  These patients require multidisciplinary care and are frequently referred to regional neonatal intensive care units (NICUs). Although mortality is low, some patients have prolonged hospitalizations, and it is unclear whether this is driven by modifiable risk factors.

Objective:

To describe a modern cohort of infants with Type C, EA/TEF and determine clinical and demographic characteristics that are related to short-term, inpatient outcomes. 

Design/Methods:

Infants with Type C, EA/TEF from April 2020 to June 2022 were included from the Children’s Hospitals Neonatal Consortium’s Database encompassing 35 participating regional, level IV NICUs in the US and Canada. Demographic and clinical data are reported. Kaplan-Meier analyses identified factors related to time to discharge (i.e., length of stay (LOS)). Inter-center variation in LOS as well as mortality and oral feedings at discharge were secondary outcomes. 
 

 

Results: In this cohort (n=292), the median gestational age, birth weight, and length of NICU stay were 38 [25^th – 75^th%ile: 34, 39] weeks, 2.56 [1.97, 3.02] kg, and 26.5 [15.5, 49] days respectively. Two hundred forty-four were discharged home, 25 (8.6%) died, 7 were transferred to another facility, and 16 were transferred to an intra-hospital service and were later readmitted to the NICU.  Exclusive oral feedings at discharge were common (75%).  Infants discharged from the NICU > 26.5 days were born smaller (2.24g vs 2.78 kg), less mature (36 vs. 38 weeks’ gestation) and were more likely to have had post-operative anastomotic leak (19% vs 7%) or stricture seen on esophagram (30% vs 16%, p< 0.01 for all). Independent of gestational age, post-operative anastomotic leak (Figure 1: hazard ratio (HR) 0.69; 95% CI=0.48, 0.98) was associated with an increased time to discharge/LOS. Infants with anastomotic leaks experienced a longer use of central lines (median 25 vs. 12 d, p< 0.001).  There was significant center variation in LOS, as seen in Figure 2 (p< 0.01).  
 

Conclusion(s):

In this large, contemporary, multicenter cohort of infants with Type C, EA/TEF, post-operative anastomotic esophageal leaks were associated with longer LOS.  Also, our results reinforce that full-term delivery may confer post-natal benefits toward shorter hospitalizations for these high-risk infants. The observed inter-center variations offer opportunities for future research and improvement.