Pediatr Int. 2026 Jan-Dec;68(1):e70564. doi: 10.1111/ped.70564.
ABSTRACT
BACKGROUND: This study aimed to characterize VACTERL-associated anomalies in patients with esophageal atresia (EA), with particular emphasis on skeletal anomalies.
METHODS: 168 EA patients were evaluated as those with a distal TEF (D-TEF) (86.9%), those without D-TEF (9.5%), and isolated TEF (3.6%). In the D-TEF subgroup, a gap length of ≥ 4 vertebral-body was defined as long-gap EA (15.8%). Baseline neonatal chest and spine radiographs were reviewed using a standardized protocol.
RESULTS: The mean gestational age was 36.41 ± 3.04 weeks. The mean birth weight was 2525.35 ± 728.52 g. Long-gap D-TEF patients had lower gestational age and birth weight (p = 0.014 and p = 0.001, respectively). Vertebral, rib, renal, limb, and cardiac anomalies and anorectal malformations (ARM) were present in 17.9%, 14.9%, 19.6%, 9.5%, 38.1%, and 12.5%, respectively. Vertebral and rib anomalies were significantly associated (p < 0.05). Exploratory analyses suggested differences in vertebral-anomaly location across EA subtypes (nominal p = 0.038) and in limb-anomaly frequency across anatomic EA subtypes (nominal p = 0.047). ARM was more frequent in long-gap than short-gap D-TEF (30.4% vs. 8.9%; p = 0.010). It remained significant across sensitivity analyses using alternative gap-length thresholds. VACTERL association was present in 25.0% of the cohort, without a significant association with anatomic subtype.
CONCLUSIONS: Skeletal anomalies were common across EA phenotypes with possible subtype-related differences in their distribution. A standardized assessment on baseline radiographs may improve VACTERL phenotyping and provide a more accurate description of the musculoskeletal burden in patients with EA. The association between ARM and greater gap length in D-TEF should be interpreted within the present cohort and the study-specific gap-length definition.
PMID:42952155 | DOI:10.1111/ped.70564