In a retrospective observational study of 41 neonates with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF), delaying thoracoscopic repair to about 2.38 days of life was not linked to more respiratory distress: rates were 34% with delayed surgery vs 40% with day-1 repair. The study also found no meaningful differences in atelectasis, intubation needs, intraoperative events, or follow-up complications, supporting delayed repair when optimal surgical conditions are needed.

Why It Matters To Your Practice

• Thoracoscopic EA/TEF repair is technically demanding and may be safer to schedule when an experienced team and optimal conditions are available.

• In this 2017–2024 cohort, delaying surgery did not increase preoperative respiratory morbidity or trigger emergency surgery.

• For NPs and PAs, this supports counseling families that a short wait may be part of a planned, safe approach rather than a sign of deterioration.

Clinical Benefits

• Respiratory distress rates were similar between delayed and day-1 repair groups: 34% vs 40%.

• Atelectasis was also comparable before surgery: 11% vs 6.6%.

• Need for intubation before surgery was similar: 19% vs 13%.

• Postoperative outcomes, including intubation days, infections, atelectasis, and later complications, did not differ significantly.

Managing Risks

• This was a small, retrospective single-cohort analysis, so results should be applied cautiously to unstable neonates or centers without thoracoscopic expertise.

• No preoperative respiratory infections or emergency operations were reported, suggesting the findings fit selected patients who remained clinically stable during the wait.

• Continue close monitoring for respiratory disorder signs, aspiration risk, oxygen needs, and changes that could require earlier intervention.

The Bottom Line

• For stable neonates with EA and distal TEF, a brief delay to enable thoracoscopic repair under optimal conditions was not associated with more respiratory distress or higher morbidity.

• Use the infant’s stability and local surgical expertise to guide timing, while reassuring families that a short planned delay can be appropriate.