Case report of two neonates with esophageal atresia and phrenic nerve palsy managed with stepwise respiratory and surgical strategies

This publication is a case report involving two neonates with type III esophageal atresia who experienced phrenic nerve palsy. The authors describe the management strategies employed for these extremely rare complications, noting that global experience with this condition is limited. No comparator group was included in this report, and statistical measures such as p-values or confidence intervals were not reported.

The first neonate achieved full recovery after five weeks of non-invasive respiratory support. The second neonate underwent diaphragmatic plication following six weeks of failed conservative management and also experienced successful recovery. Absolute numbers indicate that 1 of 2 cases recovered with non-invasive support, and 1 of 2 cases recovered after surgical intervention.

Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported for either intervention. The authors acknowledge that the report is limited by the small sample size and the rarity of the complication. They recommend a stepwise approach that includes intraoperative phrenic nerve monitoring, early diagnosis using bedside x-ray and ultrasound, an initial trial of 4–6 weeks of non-invasive support, and reserving diaphragmatic plication for cases where weaning fails.

Given the constraints of a case report, these findings should not be used to infer causality or to generalize outcomes to a broader population. The certainty of the evidence is low due to the lack of randomization and control groups.