Objectives: To identify the factors that result in a restrictive ventilatory impairment during childhood following type III esophageal atresia (EA) repair. Study design: A multicentre, retrospective, national cohort study was conducted on 503 patients who had undergone surgery for EA between 2008 and 2013. The results of pulmonary function tests (PFT) performed during childhood were used to compare patients with pure restrictive lung impairment to children with normal PFT. Subsequently, logistic regression was employed to ascertain potential risk factors for restrictive syndrome in type III EA. Results: The cohort comprised 503 patients, of whom 216 (42.9%) had interpretable PFT. Among them, 63.4% exhibited normal results, 26.9% pure restriction, 5.1% pure obstruction, and 4.6% a mixed pattern. Patient associated factors that were associated with a restrictive impairment were birth weight, Caucasian ethnicity (odds ratio (OR) 4.3 [1.2 to 15.4]), and the presence of neonatal heart defects (OR = 5.8). [1.9 to 16.9]), tracheomalacia (OR = 4.1 [1.6 to 10.2]) and neonatal GERD (OR = 3.1 [1.3 to 7.4]). The sole healthcare associated factor was the use of respiratory crisis treatment during childhood (OR = 4.8 [1.3 to 18.0]), whereas neither surgical factor nor postoperative parietal thoracic deformity was associated with restriction. Conclusion: In contrast to surgical approaches or chest wall abnormalities, neonatal EA-associated conditions appear to be associated with a restrictive pattern during childhood, but further prospective studies remain mandatory to validate these results.

The authors have declared no competing interest.

This study was funded by the University Hospital Centre of Angers (grant number 49RC19_0185_2), the non-profit sector association "Institut de Recherche en Sante Respiratoire des Pays de la Loire (IRSR-PdL)" and the "Filiere des Maladies rares Abdomino-THOraciques (FIMATHO)".

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Ethics committee of the University Hospital Centre of Angers (France) gave ethical approval for this work.

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