Adult outcomes following neonatal oesophageal atresia: more reasons to be concerned?

Oesophageal atresia (OA), with or without tracheoesophageal fistula, is a rare developmental anomaly of the foregut, affecting between 1 in 3500 to 1 in 4100 live births. Affected infants undergo surgical repair in the first days to weeks of life, and with advances in surgical and neonatal care, >90% survive into adulthood. There is, however, significant long-term multisystem morbidity, including respiratory, when compared to other neonatal developmental conditions. Specifically, OA is associated with congenital airway anomalies, classically tracheomalacia (nearly universal). Oesophageal dysmotility and swallowing difficulties are commonly associated with oropharyngeal dysphagia and primary and/or secondary aspiration. 1 Airway clearance is impaired, and there is increased morbidity, including hospitalisation, associated with childhood respiratory infections. The focus of long-term care has been related to oesophageal and tracheal calibre and function.