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Background: The aim of this study was to determine a predictive index for the risk of anastomotic leak following esophageal atresia anastomosis, METHODS: This article reviewed the clinical data of 74 children with esophageal atresia in Fujian Children's hospital. The risk factors for anastomotic leak were analysed, and a new predictive index was proposed.Results: The incidence of anastomotic leak was 29.7% after anastomosis in 74 children with esophageal atresia. Birth weight and gap length were risk factors for anastomotic leak. Logistic regression analysis showed that birth weight (Wald 2 = 4.528, P = 0.033, OR = 0.273) was a protective factor for anastomotic leak, whereas gap length (Wald 2 = 7.057, P = 0.008, OR = 2.388) was a risk factor for anastomotic leak. The ratio of gap length to birth weight had a positive predictive effect on the occurrence of anastomotic leak (AUC = 0.732, P = 0.002).Conclusion: Birth weight and gap length are important predictors of anastomotic leak in esophageal atresia. Measurement of the ratio of gap length to birth weight is a helpful predictive index for anastomotic leak following the anastomosis of esophageal atresia. [ABSTRACT FROM AUTHOR]