Early postoperative inflammatory markers associated with anastomotic leakage after repair of congenital esophageal atresia

Early clinical signs of anastomotic leakage (AL) after congenital esophageal atresia (EA) repair are often subtle; therefore, adjunctive early indicators are needed. This was a single-center retrospective study of a cohort of infants undergoing radical EA repair between 2000–2024. White blood cell count (WBC), C-reactive protein (CRP), and the Noble and Underwood (NUn) score were assessed on postoperative day (POD) 1 and POD2. AL was diagnosed by routine contrast esophagography on POD7–9. Discrimination was evaluated using receiver operating characteristic analysis. Thirty-one infants were included in the study, of which eight (25.8%) developed AL. The WBC count, CRP, and NUn scores on POD1 and POD2 were higher in the AL group (all p < 0.05). On POD1, the WBC count (area under the curve [AUC] 0.853) and NUn score (AUC 0.859) had a sensitivity of 87.5% and negative predictive value of 94.7%. On POD2, the WBC count and NUn score had a specificity of 91.3%. Inflammatory markers, particularly the WBC count and the NUn score, were associated with AL within 48 h after EA repair and may help rule out AL on POD1 and support suspicion of AL on POD2.