Epidemiology and Outcomes of Congenital Esophageal Atresia in Croatia: A Retrospective Population-Based Study

Before a baby takes its first breath, the body has already completed a complex series of construction projects. One of these involves separating the tube that carries air to the lungs from the tube that carries food to the stomach. In a healthy development, these two pathways form distinct, parallel channels. Sometimes, however, this separation goes wrong, leaving the esophagus—the food tube—broken or disconnected. This condition, known as esophageal atresia, means a newborn cannot swallow milk or water, and in many cases, a small, abnormal connection forms between the windpipe and the esophagus, allowing air to escape into the stomach or stomach contents to enter the lungs. Because the body cannot function without the ability to eat, this is a medical emergency that requires immediate surgical repair. While doctors have long known how to fix this defect, understanding how often it happens, what other health issues often accompany it, and how well babies survive the treatment remains vital for improving care.

In a comprehensive look at this condition across Croatia, researchers gathered medical records from every major hospital in the country that treats newborns with serious surgical needs. They examined data from over a decade, spanning from 2010 to 2020, to create a complete picture of the situation. During this time, the total number of babies born in Croatia decreased, yet the number of infants born with this specific esophageal defect remained steady. The team found 101 babies with the condition, which translates to roughly 2.64 cases for every 10,000 live births. This rate did not show a clear pattern of rising or falling over the years; instead, the numbers fluctuated slightly from year to year, suggesting that the occurrence of the defect is a stable, random event rather than one driven by a specific, changing environmental factor during that decade.

When the researchers looked closely at the babies themselves, they found that most were born full-term and weighed more than 2,500 grams, indicating that the defect is not strictly tied to premature birth or low weight. The most common form of the condition, found in nearly 90 percent of the cases, involved a break in the esophagus with a small connection to the windpipe at the bottom. This specific type is the one surgeons are most familiar with and generally have the best success rates for repairing. The study also revealed that more than half of the babies had other birth defects alongside the esophageal issue. The most frequent companions were problems with the heart and major blood vessels, followed by a cluster of defects known as VACTERL, which involves issues with the spine, anus, kidneys, and limbs. Interestingly, the pattern of these extra defects in Croatia differed slightly from what is seen in some other European studies, with heart problems appearing less often and the VACTERL cluster appearing more often.

Despite the availability of advanced ultrasound technology, the study highlighted a significant gap in early detection. In only three out of the 101 cases did doctors identify the problem before the baby was born. While some mothers showed signs of having too much amniotic fluid, a common clue that might hint at a swallowing problem, this sign was not followed up with further investigation in most cases. As a result, the vast majority of families received the news of the diagnosis only after their child was delivered. The outcome for these newborns was generally positive, with the majority surviving the first month of life. The overall death rate within that first month was just under 12 percent, a figure that aligns with survival rates seen in other developed European nations. The few babies who did not survive typically had severe complications beyond the esophageal defect itself, such as extreme prematurity or multiple major organ failures.

The researchers concluded that while the medical care in Croatia is effective and the survival rates are strong, there is a clear opportunity to improve how these cases are managed before birth. The low rate of prenatal detection means that families are often unprepared for the immediate medical needs of their child, and babies are frequently transferred to specialized centers after they are already in distress. The study suggests that better prenatal screening could allow for earlier planning and transfer to the right hospital before delivery, giving parents time to prepare emotionally and medically. By establishing a national registry to track these patients over their entire lives, doctors hope to better understand the long-term challenges these survivors face, ensuring that the care they receive continues to improve long after the initial surgery is complete.