Management of Esophageal Atresia at Tertiary Centres in Anambra State: A Professional Case Review

Esophageal atresia (EA) with or without tracheoesophageal fistula is a neonatal surgical emergency associated with high mortality in developing countries. This professional case review examines the management approaches, operative outcomes, and prognostic factors of esophageal atresia cases managed at tertiary institutions in Anambra State, South East Nigeria, from 2019 to 2023. Case records of 35 neonates with confirmed EA were reviewed across two tertiary centers. Data analyzed included gestational age at birth, birth weight, EA type (Gross classification), associated anomalies, operative approach, time to definitive surgery, and neonatal survival outcomes. Type C EA (distal tracheoesophageal fistula) was the most prevalent, constituting 71% of cases. Associated cardiac anomalies were present in 26% of neonates. Primary esophagoesophagostomy was attempted in 63% of cases, with anastomotic leak in 19%. Overall survival was 54%, with low birth weight and associated cardiac defects as the strongest predictors of mortality. Limited availability of neonatal intensive care unit (NICU) beds was the most critical system-level determinant of outcome. The study recommends investment in neonatal surgical infrastructure, neonatologist-surgeon co-management protocols, and a structured referral pathway for EA in South East Nigeria. Keywords: esophageal atresia, neonatal surgery, tracheoesophageal fistula, Anambra, neonatal outcomes