Developmental vulnerability in infants and toddlers following esophageal atresia repair: A parent-reported functional assessment using WIDEA-FS.

Objective

To characterize early adaptive and functional neurodevelopment after esophageal atresia (EA) repair using the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS) compared with healthy controls.

Study design

WIDEA-FS assessments were obtained from preterm (n = 18) and term-born (n = 19) children following repair of short-gap (n = 23) or long-gap EA (n = 14), with or without tracheoesophageal fistula, and from healthy term-born controls (n = 19), between 11 and 40 months of age. Total and domain scores (self-care, mobility, communication, social cognition) were compared using general linear modeling and age-stratified analyses according to gestational age (term-born vs. preterm) and surgical subtype (shot-gap vs. long-gap EA). Functional vulnerability was classified using published WIDEA-FS reference criteria and compared with clinician-documented developmental concerns. Early intervention utilization was also characterized in the patient cohort.

Results

Total and domain-specific scores increased significantly with age across all groups (p < 0.001). Children following EA repair demonstrated lower total and self-care scores than healthy controls, irrespective of gestational age or surgical subtype (p < 0.05). No group differences emerged for mobility, communication, or social cognition scores. Classification using published WIDEA-FS reference criteria identified a subset of children with communication and social-cognitive vulnerabilities, with communication-related vulnerability observed exclusively among children with EA. WIDEA-FS scoring demonstrated moderate concordance with clinician-documented concerns (sensitivity 75%, specificity 77%, negative predictive value 97%). The majority of children with EA (86%) received early intervention services, most commonly physical and feeding therapy.

Conclusion

Overall, children demonstrated age-appropriate adaptive functioning after EA repair. However, a subset exhibited domain-specific functional vulnerabilities, particularly in communication and social cognition. The high utilization of early intervention services likely contributed to favorable functional outcomes, potentially underestimating the underlying developmental vulnerability in this population. These findings support continued neurodevelopmental surveillance and highlight the potential utility of parent-reported measures for early identification of children who may benefit from targeted developmental interventions.