Objective:To investigate the risk factors for in-hospital mortality in neonates with congenital esophageal atresia(CEA)and to develop a prediction score model for prognosis. Methods:All infants with CEA treated in the Children’s Hospital of Chongqing Medical University between Mar 2004 and May 2016 were included in present study. Risk factors were compared between survivor group and non-survivor group infants. A prediction score model was developed according to the regression coefficients of risk factors.Results:The mortality was 18.1%(36/198). In univariate analysis

higher incidence of prematurity

low birth weight

long gap

anastomotic leak

respiratory failure

postoperative sepsis

respiratory distress syndrome

pneumothorax and septic shock were found in nonsurvivor group when compared with those of survivor group(P<0.05). In logistic regression analysis

anastomotic leak(OR=10.75

95%CI=3.113 to 37.128)

respiratory failure(OR=4.104

95%CI=2.292 to 7.355)

postoperative sepsis(OR=3.564

95%CI=1.516 to 8.375)and low birth weight(OR=8.379

95%CI=3.357 to 20.917)were associated with the high mortality(P<0.05). A predictive score system was developed and the area under receiver operating characteristic curve of the score was 0.902(95%CI=0.859 to 0.945) for death from CEA. At the cutoff point of 2

a sensitivity of 0.861

a specificity of 0.827

a positive predictive value of 0.525 and a negative predictive value of 0.964 were obtained from this model. Three risk groups were defined:the ‘low’risk group(0 to 1 score)

the‘moderate’risk group(2 to 4 score)and the ‘high’risk group(≥5 score). Mortality rate significantly increased in the ‘high’risk group(100%)when compared with the ‘low’or ‘moderate’risk group(3.6%

49.1%

respectively

χ2=73.198

P=0.000). Conclusion:Anastomotic leak

respiratory failure

postoperative sepsis and low birth weight are independent risk factors for mortality of CEA. Infants with higher score had higher morality according to this predictive score system.