{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:34:22Z","timestamp":1793064862008,"version":"4.5.0"},"reference-count":64,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children with repaired esophageal atresia with or without tracheoesophageal fistula (EA\/TEF) frequently have chronic respiratory morbidity, but airway inflammation is poorly defined. We described bronchoalveolar lavage (BAL) cell patterns in symptomatic EA\/TEF and compared them with primary ciliary dyskinesia (PCD), protracted bacterial bronchitis (PBB), and healthy controls (HC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      BAL profiles from symptomatic EA\/TEF patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200944) were analyzed against PCD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), PBB (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921), and HC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916). Endoscopic bronchitis severity was assessed using the BScore. Associations between BScore and BAL profiles were assessed using multivariable modeling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All EA\/TEF patients had pulmonary exacerbations. BAL neutrophils were higher in EA TEF than HC (median 8.0%, IQR 3\u201325 vs 1.0%, IQR 0\u20132,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and similarly elevated in PBB and PCD. BScore correlated with neutrophils (Spearman rho 0.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and independently predicted neutrophilic inflammation (beta 4.53, 95% CI 1.78\u20137.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Pathogenic bacteria were cultured in 61%, most commonly\n                      <jats:italic>Haemophilus influenzae<\/jats:italic>\n                      (29.5%) and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (25.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to systematically demonstrate neutrophil-driven airway inflammation in symptomatic children with repaired EA\/TEF. These findings underscore the need for structured pulmonary follow up and the evaluation of anti inflammatory strategies in EA\/TEF patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Children with repaired EA\/TEF and respiratory symptoms show frequent pulmonary exacerbations and neutrophil driven BAL inflammation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Neutrophil levels resemble protracted bacterial bronchitis and primary ciliary dyskinesia and track bronchoscopic bronchitis severity.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Bronchoscopic bronchitis severity tracks neutrophilic inflammation and independently predicts it.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Bacterial pathogens are common in BAL of EA\/TEF children, supporting infection related airway injury risk.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Results inform phenotype driven care pathways to reduce exacerbations and long term airway damage in EA\/TEF children.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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