Background and Aim: Atresia is the most common congenital anomaly of the esophagus, with an increased risk of complications after surgical correction. The aim of our study was to evaluate the risk factors associated with early and late postoperative complications in neonatal patients with esophageal atresia. Methods: The study sample comprised 109 neonatal patients aged between 0 and 27 days of life who were prenatally diagnosed with esophageal atresia or diagnosed at birth. For the purpose of this study, neonatal and perinatal factors and factors associated with the mother’s medical condition were analyzed. Complications after surgical intervention were classified as early and late. Results: Patients with early postoperative complications experienced significantly more frequent complications during delivery (p = 0.002), asphyxia (p = 0.038), and postoperative sepsis (p = 0.045) and were more likely to have received medicamentous therapy (p = 0.035). Patients with late postoperative complications had significantly more frequent complications during delivery (p = 0.025), respiratory distress (p = 0.043), and postoperative sepsis (p = 0.010), were more likely to have received preoperative mechanical ventilation (p = 0.014), and showed a significantly different frequency distribution among the different classes of the Spitz classification (p = 0.008). A risk factor for early postoperative complications in patients with atresia in the upper part was complications during delivery (OR-3.09; p = 0.007). The risk factors for late postoperative complications for patients with upper atresia were preoperative mechanical ventilation (OR: 2.77; p = 0.041), postoperative sepsis (OR: 2.60; p = 0.028), and belonging to relatively high- and high-risk groups according to the Spitz classification (OR: 3.50; p = 0.022). Conclusions: In neonates who have undergone surgical intervention for esophageal atresia, a risk factor for early postoperative complications is complications during delivery, while the risk factors for late postoperative complications are preoperative mechanical ventilation, postoperative sepsis, and belonging to relatively high- and high-risk groups according to the Spitz classification. Therefore, a multidisciplinary approach and continuous monitoring are essential to reduce morbidity and mortality, as well as to improve quality of life, in these patients.

Background/Objectives: Neonates with surgical gastrointestinal conditions frequently require parenteral nutrition and are exposed to multiple overlapping risks for hepatobiliary, infectious, and nutritional complications. This study aimed to determine whether the timing and initial composition of parenteral nutrition (PN) were independently associated with hepatobiliary dysfunction, treatment-related complications, and nutritional outcomes. Methods: This retrospective cohort included 91 neonates hospitalized at the University Children’s Hospital between January 2024 and July 2026 who received parenteral nutrition (PN) for >5 consecutive days. Associations between PN timing, modality, duration, enteral progression, clinical severity, feeding type, and hepatobiliary, infectious, and growth outcomes were assessed using univariable and multivariable analyses. Results: Cholestasis occurred in 18 patients (19.8%) and intestinal failure-associated liver disease (IFALD) in 14 (15.4%). The interval from enteral feeding cessation to PN initiation and initial PN modality were not significantly associated with cholestasis or IFALD. Patients with IFALD had longer PN exposure than those without IFALD (21 vs. 12 days; p = 0.010). Each additional PN day increased the adjusted odds of catheter-related bloodstream infection by 9.7% (OR 1.097, 95% CI 1.032–1.167; p = 0.003). Simultaneous amino-acid and lipid initiation was associated with the highest unadjusted weight-gain velocity and numerically lowest cholestasis and IFALD rates, but no independent protective effect was established. Conclusions: Longer PN duration was associated with IFALD and CRBSI, although the IFALD association should be interpreted cautiously because PN duration contributes to its operational definition. Short delays in PN initiation and initial lipid timing were not independently associated with these outcomes. Management should remain individualized, with advancement of enteral nutrition when clinically feasible and minimization of unnecessary PN and central-line exposure.