682 - Congenital intestinal atresia with a mesenteric defect is associated with a higher rate of complications

Publication Number: 1659.682

Elena Itriago, Baylor College of Medicine, Houston, TX, United States; Laura Gollins, Texas Children's Hospital, Houston, TX, United States; Muralidhar H. Premkumar, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Emily Sabatini, Baylor College of Medicine, Houston, TX, United States; Amy B. Hair, Baylor College of Medicine, Houston, TX, United States

Background: Jejunal-ileal (JI) atresia increases neonatal complications in the NICU. It is classified into four types, with types III and IV involving a mesenteric defect. These classifications are important as they are associated with short bowel syndrome, often due to extensive small bowel resection, which raises the risk of intestinal failure, defined as requiring parenteral nutrition for at least 60 days within 74 days.

Objective: To compare the clinical outcomes of infants with jejunal atresia based on the presence or absence of a mesenteric defect, focusing on its impact on morbidity, surgical outcomes, and overall prognosis.

Design/Methods: Single-center, retrospective cohort study to evaluate outcomes of infants diagnosed with intestinal atresia between 2014 and 2023. Key variables included the development of intestinal failure, hospital length of stay, and complications associated with intestinal failure. Intestinal failure was defied as the need for PN for at least 60 days within a 74-day period. Intestinal atresia was classified as either simple or complex, based on the absence or presence of a mesenteric defect, respectively. Infants with gastroschisis, those who were transferred to another facility, and those who did not survive their NICU hospitalization were excluded from the analysis.

Results: A total of 49 patients were studied, with 23 having simple atresia and 26 complex atresia. The average birthweight was 2502 + 757 g (mean + SD) for the cohort. Intestinal failure was more common in complex atresia (15 patients) compared to simple atresia (5 patients, p = 0.07). Within the complex group, 11 infants had intestinal perforation, and 13 needed an ostomy. The median bowel length was shorter in the complex group (109 cm) than in the simple group (121 cm; p = 0.041). Complex atresia infants had higher rates of small intestinal bacterial overgrowth (p = 0.016) and gastroesophageal reflux disease (p = 0.042). They also experienced longer NPO status (median 21 vs. 10 days, p = 0.029) and required more prolonged parenteral nutrition (median 80 vs. 21 days, p = 0.057). Hospital stays were longer for complex atresia infants (median 108 days) compared to simple atresia (median 32 days; p = 0.009). All simple atresia infants achieved enteral autonomy, while 84% of complex atresia infants did.

Conclusion(s): In conclusion, infants with intestinal atresia face heightened risks of intestinal failure and complications during NICU admission, especially with mesenteric defects. This highlights the importance of careful management and further research to improve outcomes.

Table 1. Baseline Demographics and Clinical Characteristics
1. Mean ± standard deviation, 2-sample t-test p-value
2. Median (interquartile range), Wilcoxon rank sum test p-value
3. Frequency (%), Fisher's exact test p-value

Table 2. Nutritional Characteristics
1. Mean ± standard deviation, 2-sample t-test p-value
2. Median (interquartile range), Wilcoxon rank sum test p-value
3. Frequency (%), Fisher's exact test p-value

Table 3. Patients Discharge Characteristics
1. Mean ± standard deviation, 2-sample t-test p-value
2. Median (interquartile range), Wilcoxon rank sum test p-value