{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:01:12Z","timestamp":1792188072053,"version":"4.4.0"},"reference-count":71,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is limited knowledge regarding the impact of perioperative critical care on frequency of neurological imaging findings following esophageal atresia (EA) repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study of infants (<jats:italic>n<\/jats:italic>\u2009=\u200970) following EA repair at a single institution (2009\u20132020). Sex, gestational age at birth, type of surgical repair, underlying disease severity, and frequency of neurologic imaging findings were obtained. We quantified the length of postoperative pain\/sedation treatment and anesthesia exposure in the first year of life. Data were presented as numerical sums and percentages, while associations were measured using Spearman's Rho.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Vertebral\/spinal cord imaging was performed in all infants revealing abnormalities in 44% (31\/70). Cranial\/brain imaging findings were identified in 67% (22\/33) of infants in the context of clinically indicated imaging (47%; 33\/70). <jats:italic>Long\u2010gap<\/jats:italic> EA patients (<jats:italic>n<\/jats:italic>\u2009=\u200916) received 10 times longer postoperative pain\/sedation treatment and twice the anesthesia exposure compared with <jats:italic>short\u2010gap<\/jats:italic> EA patients (<jats:italic>n<\/jats:italic>\u2009=\u200954). The frequency of neurologic imaging findings did not correlate with underlying disease severity scores, length of pain\/sedation treatment, or cumulative anesthesia exposure. Lack of associations between clinical measures and imaging findings should be interpreted with caution given possible underestimation of cranial\/brain findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We propose that all infants with EA undergo brain imaging in addition to routine spinal imaging given the high burden of abnormal brain\/cranial findings in our cohort. Quantification of pain\/sedation and anesthesia exposure in <jats:italic>long\u2010gap<\/jats:italic> EA patients could be used as indirect markers in future studies assessing the risk of neurological sequelae as evidenced by early abnormalities on brain imaging.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2269","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T06:54:01Z","timestamp":1699426441000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure"],"prefix":"10.1002","volume":"116","author":[{"given":"Maggie Jean","family":"McMahon","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"},{"name":"School of Medicine, Tufts University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon Michael","family":"Evanovich","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"},{"name":"School of Medicine, Tufts University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle Bennet","family":"Pier","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Neurology Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie Shea","family":"Kagan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue Teresa","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Zendejas","sequence":"additional","affiliation":[{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"},{"name":"Department of Surgery, Esophageal and Airway Treatment Center Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell William","family":"Jennings","sequence":"additional","affiliation":[{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"},{"name":"Department of Surgery, Esophageal and Airway Treatment Center Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zurakowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3943-2105","authenticated-orcid":false,"given":"Dusica","family":"Bajic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,7]]},"reference":[{"issue":"6","key":"e_1_2_12_2_1","first-page":"38","article-title":"ASA provides examples to each ASA physical status class","volume":"79","author":"Abouleish A. 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