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Tracheal Work of Breathing in Neonates With Tracheoesophageal Fistula Before and After Surgical Repair via Computational Fluid Dynamics Assessment

Year: 2025

Type: article

Abstract: INTRODUCTION: Tracheoesophageal fistula (TEF), often occurring with esophageal atresia (EA), presents significant respiratory challenges in neonates. Neither the effect of EA/TEF, nor the effect of post-surgical complications such as tracheomalacia, on respiratory effort has been previously quantified. This study calculates the tracheal resistive component of work of breathing (TR-WOB) to quantify breathing effort pre- and post-surgical repair of EA/TEF. The primary objective of this study was to calculate the TR-WOB before and after surgical repair and compare it to normal values. METHODS: Five neonates with EA/TEF underwent ultrashort echo time (UTE) MRI before and after surgical repair. Virtual airway models were segmented from the MRI, with airway motion calculated via registration of respiratory-gated MRI. Computational fluid dynamic (CFD) simulations based on these virtual airways modeled patient-specific airflow calculated TR-WOB. Tracheal cross-sectional area (CSA) was quantified to reveal the relationship between airway anatomy and TR-WOB. RESULTS: Mean TR-WOB decreased from 686 ± 1013 J/day pre-surgery to 116 ± 159 J/day post-surgery (p = 0.299, Cohen's d = 0.301). In some subjects, TR-WOB remained elevated post-surgically compared to healthy neonates reported in previous studies. Four of five subjects showed increased tracheal CSA post-surgery (23 % mean increase). A strong negative correlation was found between average CSA and TR-WOB post-surgery (ρ = -0.90, p = 0.037), suggesting anatomical improvements reduce breathing effort. CONCLUSION: Surgical repair of EA/TEF reduces TR-WOB, but TR-WOB remains abnormally high in some patients. CFD-based assessments offer a quantitative tool for identifying neonates who may benefit from additional interventions to reduce TR-WOB during their EA-TEF repair. LEVEL OF EVIDENCE: 4 Case Series.

Source: Journal of Pediatric Surgery

DOI: 10.1016/j.jpedsurg.2025.162630