Associations of perioperative characteristics with motor function in preschool children born with esophageal atresia.

BACKGROUND Children born with esophageal atresia experience long-term neurodevelopmental deficits, with unknown origin. AIMS To find associations between perioperative variables during primary esophageal atresia repair and motor function at age 5 years. METHODS This ambidirectional cohort study included children born with esophageal atresia who consecutively had been operated on in the Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam from January 2007 through June 2013. The perioperative data of this cohort were collected retrospectively; the motor function data prospectively. RESULTS After exclusion of patients with syndromal congenital diseases (n=8) and lost to follow-up (n=10), the data of 53 children were included. The mean (SD) total motor function impairment z-score at 5 years of age was -0.66 (0.99), significantly below normal (P <0.001). In multivariable linear regression analysis, number of postoperative days endotracheal intubation (B= -0.211, 95% CI: -0.389 - -0.033, p= 0.021) was negatively associated with motor outcome, whereas high blood pressure (B=0.022, 95% CI 0.001 - 0.042, p=0.038) was positively associated. Preoperative nasal oxygen supplementation versus room air (B= 0.706, 95% CI: 0.132 - 1.280, p=0.016) was positively associated with motor outcome, which we cannot explain. CONCLUSIONS Motor function in 5-year-old esophageal atresia patients was impaired and negatively associated with the number of postoperative days of endotracheal intubation and positively associated with high blood pressure. Prospective studies with critical perioperative monitoring and monitoring during stay at the intensive care unit are recommended.