Mortality and Factors Associated with Death in Children with Congenital Gastrointestinal Malformations-A Five-Year Retrospective Study from Romania (2020-2024).

Background/Objectives: Congenital gastrointestinal malformations (CGIMs) remain a significant cause of pediatric mortality, particularly during the neonatal period in resource-limited settings. Mortality varies widely, across conditions and healthcare systems, yet data from Eastern European centers remain limited. We aimed to determine mortality during index admission and identify baseline factors associated with death among children with CGIMs treated at our tertiary surgical center, including the COVID-19 pandemic years. Methods: We conducted a single-center retrospective study (January 2020-December 2024) of all consecutive children admitted with congenital gastrointestinal malformations. The primary outcome was death during index admission. Secondary mortality outcomes included death within 30 days of admission and 30-day postoperative mortality. Comparisons were performed between survivors and non-survivors. Data were extracted from medical records and potential risk factors of mortality were evaluated using univariable analyses and multivariable logistic regression. Statistical analysis was performed using SPSS version 31 (IBM) and a p-value of <0.05 was considered statistically significant. Results: Overall, index-admission mortality was 11.7% (27/231), with 55.6% of deaths occurring within 30 days from admission and 85.2% occurring postoperatively. Mortality was highest among patients with cloacal malformations, duodenal atresia/stenosis, and esophageal atresia ± tracheoesophageal fistula. Deaths occurring during the neonatal period accounted for 85% of all deaths. Compared with survivors, non-survivors had significantly lower birth weight, gestational age, and Apgar scores, increased ASA score, and higher rates of prematurity, syndromic conditions, associated anomalies, and sepsis. In multivariable analysis, prematurity remained independently associated with index-admission mortality (adjusted OR 3.20, 95% CI 1.23-8.31; p = 0.017). In an exploratory multivariable analysis including in-hospital complications, sepsis was strongly associated with mortality (adjusted OR 8.63, 95% CI 3.16-23.55, p < 0.001). Conclusions: Mortality during index admission remained substantial among children with congenital gastrointestinal malformations. Prematurity was the only baseline characteristic independently associated with mortality. In an exploratory analysis, sepsis identified from retrospective clinical documentation was associated with mortality. Improved care for preterm infants and prevention of severe infection may improve outcomes. Larger multicenter studies are needed to validate these findings and refine risk stratification strategies for high-risk patients.