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Davis SE, Davis C, Patel N, Kubba H, Clement WA. Long-term Airway Outcomes and Interventions in Children With Oesophageal Atresia With Tracheoesophageal Fistula: A 20-year Single Centre Observational Study. J Pediatr Surg 2024; 59:1066-1071. [PMID: 38429129 DOI: 10.1016/j.jpedsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Airway anomalies, symptoms and interventions are commonly reported in children with oesophageal atresia with tracheoesophageal fistula (OA/TOF). The purpose of this study was to assess the incidence of these airway pathologies and those requiring interventions in the long-term. METHODS A retrospective case note review of all patients admitted to the Neonatal Unit at the Royal Hospital for Children, Glasgow between January 2000 and December 2015 diagnosed with OA/TOF. Included patients had a minimum of 5 years follow-up. RESULTS 121 patients were identified. 118 proceeded to OA/TOF repair. 115 patients had long-term follow-up data. Ninety-five (83%) children had one or more airway symptom recorded. Thirty-six (31%) neonates underwent airway endoscopy at the time of their initial OA/TOF repair. Forty-six (40%) children underwent airway endoscopy at a later date due to airway symptoms. Airway pathologies identified included airway malacia, thirty-two (28%), subglottic stenosis, eleven (10%), tracheal pouch, twenty-five (22%), laryngeal cleft, seven (6%) and recurrent fistula, five (4%). Airway interventions included endoscopic division of tracheal pouch, ten (9%), tracheostomy, seven (6%), aortopexy, six (5%), repair of recurrent fistula, five (4%), endoscopic repair of laryngeal cleft, three (3%) and four (3%) required open airway reconstruction for subglottic stenosis. One child (1%) remains tracheostomy dependent. CONCLUSIONS Long-term airway pathologies are common in children with OA/TOF. Many of these are remediable with surgical intervention. Clinicians should be cognisant of this and refer to Airway Services appropriately.
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Affiliation(s)
- Sandra E Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom.
| | - Carl Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - W Andrew Clement
- Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Children, Glasgow, United Kingdom
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McMahon MJ, Evanovich DM, Pier DB, Kagan MS, Wang JT, Zendejas B, Jennings RW, Zurakowski D, Bajic D. Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure. Birth Defects Res 2024; 116:e2269. [PMID: 37936552 DOI: 10.1002/bdr2.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/04/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is limited knowledge regarding the impact of perioperative critical care on frequency of neurological imaging findings following esophageal atresia (EA) repair. METHODS This is a retrospective study of infants (n = 70) following EA repair at a single institution (2009-2020). Sex, gestational age at birth, type of surgical repair, underlying disease severity, and frequency of neurologic imaging findings were obtained. We quantified the length of postoperative pain/sedation treatment and anesthesia exposure in the first year of life. Data were presented as numerical sums and percentages, while associations were measured using Spearman's Rho. RESULTS Vertebral/spinal cord imaging was performed in all infants revealing abnormalities in 44% (31/70). Cranial/brain imaging findings were identified in 67% (22/33) of infants in the context of clinically indicated imaging (47%; 33/70). Long-gap EA patients (n = 16) received 10 times longer postoperative pain/sedation treatment and twice the anesthesia exposure compared with short-gap EA patients (n = 54). The frequency of neurologic imaging findings did not correlate with underlying disease severity scores, length of pain/sedation treatment, or cumulative anesthesia exposure. Lack of associations between clinical measures and imaging findings should be interpreted with caution given possible underestimation of cranial/brain findings. CONCLUSIONS We propose that all infants with EA undergo brain imaging in addition to routine spinal imaging given the high burden of abnormal brain/cranial findings in our cohort. Quantification of pain/sedation and anesthesia exposure in long-gap EA patients could be used as indirect markers in future studies assessing the risk of neurological sequelae as evidenced by early abnormalities on brain imaging.
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Affiliation(s)
- Maggie Jean McMahon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Devon Michael Evanovich
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Danielle Bennet Pier
- Division of Pediatric Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Mackenzie Shea Kagan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell William Jennings
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Menso JE, Reijntjes MA, Mussies CM, van Wijk MP, Zwaveling S. Unintentional Suture Fistula Between the Proximal and Distal Esophagus in a Preterm Neonate with Type C Esophageal Atresia. European J Pediatr Surg Rep 2024; 12:e20-e22. [PMID: 38259261 PMCID: PMC10803184 DOI: 10.1055/a-2227-6252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/10/2023] [Indexed: 01/24/2024] Open
Abstract
We present the case of a patient with gross type C esophageal atresia in a preterm neonate (gestational age of 31 weeks + 1 day) with a birth weight of 1,470 g. The fistula was released via a thoracotomy, but no primary anastomosis could be made, due to an unexpected long gap. The distal esophagus was closed and approximated to the blind pouch using traction sutures until an adjacent position was reached. A gastrostomy was created for enteral feeding. Although a second attempt to make an anastomosis was unsuccessful, the patient unexpectedly developed a suture fistula 6 weeks after the first procedure, enabling feeding via a nasogastric tube. Over time, six dilations were necessary. Full enteral feeding was achieved at the age of 6 months. Our case confirms sparse reports that deliberately creating a suture fistula may be a solution in esophageal atresia patients when an unexpected long gap prohibits a primary anastomosis.
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Affiliation(s)
- Julia E. Menso
- Department of Pediatric Surgery, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Maud A. Reijntjes
- Department of Pediatric Surgery, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Carlijn M. Mussies
- Department of Gastroenterology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Michiel P. van Wijk
- Department of Gastroenterology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Sander Zwaveling
- Department of Pediatric Surgery, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
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