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Turedi B, Gollu G, Ates U, Kose K, Oner O, Bingol-Kologlu M, Yagmurlu A, Aktug T, Dindar H, Cakmak M. Neurodevelopmental evaluation of children who were operated due to congenital anomaly with the 'Ages and Stages Questionnaire (ASQ)' and 'ASQ: Social-Emotional'. Pediatr Surg Int 2024; 40:47. [PMID: 38300305 PMCID: PMC10834557 DOI: 10.1007/s00383-023-05625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The purpose of surgeries performed for congenital anomalies in children is to increase the survival rates and provide a developmental comparison to that of their peers. AIM The objective of this study was to investigate the development of children following surgery for congenital anomalies and the risk factors affecting their development. METHODS Our study included 33 children who underwent surgery for gastrointestinal anomalies in our clinic between 2011 and 2016, and did not have any syndrome, chromosomal abnormality, or additional abnormality. Developmental levels were evaluated using the Ages and Stages Questionnaire (ASQ) and the ASQ: Social-Emotional (ASQ: SE) scales adapted for the use on Turkish children. Data on patient history were obtained retrospectively from patient files. RESULTS The study included 33 patients, including 11 with esophageal atresia, 6 with intestinal atresia, 11 with anorectal malformation, and 5 with Hirschsprung's disease. Developmental delay was found in the ASQ of 72.7% of the patients and the ASQ: SE tool was 27% of the patients. The rate of patients with scores below the threshold from each parameter of ASQ was higher than that of the normal population (p < 0.05). Development delay was detected using the ASQ scale in 100% of those with microcephaly at birth, in 91% of premature infants born between 1500 and 2500 g, and in 83.3% of those with low birth weight to gestational age. CONCLUSIONS In children who underwent surgery due to congenital anomalies, an evaluation through developmental tests, a post-surgical follow-up process, and a referral to the relevant disciplines when necessary may increase the success of surgery as well as increase the life quality of the patient.
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Krishnan U, Dumont MW, Slater H, Gold BD, Seguy D, Bouin M, Wijnen R, Dall'Oglio L, Costantini M, Koumbourlis AC, Kovesi TA, Rutter MJ, Soma M, Menzies J, Van Malleghem A, Rommel N, Dellenmark-Blom M, Wallace V, Culnane E, Slater G, Gottrand F, Faure C. The International Network on Oesophageal Atresia (INoEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula. Nat Rev Gastroenterol Hepatol 2023; 20:735-755. [PMID: 37286639 DOI: 10.1038/s41575-023-00789-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Oesophageal atresia-tracheoesophageal fistula (EA-TEF) is a common congenital digestive disease. Patients with EA-TEF face gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life issues in childhood, adolescence and adulthood. Although consensus guidelines exist for the management of gastrointestinal, nutritional, surgical and respiratory problems in childhood, a systematic approach to the care of these patients in adolescence, during transition to adulthood and in adulthood is currently lacking. The Transition Working Group of the International Network on Oesophageal Atresia (INoEA) was charged with the task of developing uniform evidence-based guidelines for the management of complications through the transition from adolescence into adulthood. Forty-two questions addressing the diagnosis, treatment and prognosis of gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life complications that patients with EA-TEF face during adolescence and after the transition to adulthood were formulated. A systematic literature search was performed based on which recommendations were made. All recommendations were discussed and finalized during consensus meetings, and the group members voted on each recommendation. Expert opinion was used when no randomized controlled trials were available to support the recommendation. The list of the 42 statements, all based on expert opinion, was voted on and agreed upon.
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Affiliation(s)
- Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Michael W Dumont
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hayley Slater
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin D Gold
- Children's Center for Digestive Health Care, GI Care for Kids, LLC, Atlanta, GA, USA
| | - David Seguy
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Department of Nutrition, CHU Lille, Lille, France
| | - Mikael Bouin
- University of Montreal, CHUM Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Rene Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Thomas A Kovesi
- Deptartment of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Rutter
- Division of Paediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Marlene Soma
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Otolaryngology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Nathalie Rommel
- Department of Gastroenterology, Department of Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, ExpORL, Deglutology, University of Leuven, Leuven, Belgium
| | - Michaela Dellenmark-Blom
- Department of Paediatric Surgery, The Queen Silvia Children's hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Wallace
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Graham Slater
- EAT Oesophageal Atresia Global Support Groups e.V., Stuttgart, Germany
| | - Frederic Gottrand
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
- Institute for Translational Research in Inflammation INFINITE, Inserm Faculté de Médecine, Université de Lille, Lille, France
| | - Christophe Faure
- Division of Paediatric Gastroenterology & Oesophagus Development and Engineering Lab, Sainte-Justine Hospital, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
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Kassa AM, Håkanson CA, Lilja HE. The risk of autism spectrum disorder and intellectual disability but not attention deficit/hyperactivity disorder is increased in individuals with esophageal atresia. Dis Esophagus 2022:doac097. [PMID: 36544426 DOI: 10.1093/dote/doac097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/23/2022] [Indexed: 06/17/2023]
Abstract
Knowledge of neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability (ID) in patients with esophageal atresia (EA) is scarce. The aims of this study were to investigate the prevalence and risk of ADHD, ASD and ID in individuals with EA. Data were obtained from four longitudinal population-based registries in Sweden and analyzed using Cox proportional hazards regression. Patients with EA born in Sweden in 1973-2018 were included together with five controls for each individual with the exposure matched on sex, gestational age at birth, birth year and birth county. Individuals with chromosomal aberrations and syndromes were excluded. In total, 735 individuals with EA and 3675 controls were included. Median age at time of the study was 20 years (3-48). ASD was found in 24 (3.9%), ADHD in 34 (5.5%) and ID in 28 (4.6%) individuals with EA. Patients with EA had a 1.66 times higher risk of ASD (95% confidence interval [CI], 1.05-2.64) and a 3.62 times higher risk of ID (95% CI, 2.23-5.89) compared with controls. The risk of ADHD was not significantly increased. ADHD medication had been prescribed to 88.2% of patients with EA and ADHD and to 84.5% of controls with ADHD. Individuals with EA have a higher risk of ASD and ID than individuals without the exposure. These results are important when establishing follow-up programs for children with EA to allow timely detection and consequentially an earlier treatment and support especially before school start.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Trivedi A, Browning Carmo K, James-Nunez K, Gordon A. Growth and risk of adverse neurodevelopmental outcome in infants with congenital surgical anomalies: a systematic review. Pediatr Surg Int 2022; 39:3. [PMID: 36441273 DOI: 10.1007/s00383-022-05305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
Survival of infants with congenital anomalies requiring surgical correction has increased dramatically, shifting the focus of clinical care and research toward optimising growth and neurodevelopment.To determine the impact of growth on neurodevelopmental outcomes of infants with congenital surgical anomalies. Studies that reported association of growth with developmental outcomes in infants with congenital anomalies who had surgery, were eligible for inclusion. The search strategy was prospectively drafted, and relevant studies were identified by electronic searches. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2022, issue 1), MEDLINE and EMBASE from their earliest date to February 2022 were searched. Seven studies met the inclusion criteria. Variability in selection of growth measures, developmental assessment tools and assessment endpoints for neurodevelopment, precluded a meta-analysis. Four studies reported the association between growth and neurodevelopmental outcomes in infants with gastroschisis with two noting adverse outcomes in infants who were small for gestational age. Birthweight, reported in four studies, was not associated with adverse developmental outcomes. Postnatal growth, reported in three studies, was associated with adverse outcome. The data linking growth restriction in infants with congenital surgical anomalies and neurodevelopmental outcome is limited. There is limited published research examining the longitudinal effects of intra- and extra-uterine growth parameters on neurodevelopmental outcomes.
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Affiliation(s)
- Amit Trivedi
- Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Kathryn Browning Carmo
- Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kristen James-Nunez
- Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Newborn Care, Royal Price Alfred Hospital, Camperdown, NSW, Australia
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5
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Wang P, Yang S, Hua K, Yang Z, Li S, Liao J, Zhang Y, Zhao Y, Gu Y, Li S, Huang J. Growth assessments for children with recurrent tracheoesophageal fistulas. Pediatr Surg Int 2022; 38:1125-1130. [PMID: 35643795 DOI: 10.1007/s00383-022-05142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the growth status of children with recurrent tracheoesophageal fistula (rTEF), and determine the possible risk factors of growth retardation (GR). METHODS The medical records of 83 patients with rTEF who underwent surgical repair were retrospectively analyzed. The patients were retrospectively divided into two groups according to whether they had GR. The clinical variables were compared between the GR and non-GR groups. Univariate and multivariable logistic regression analysis were performed to identify the risk factors for GR. RESULTS Eighty-three children diagnosed with rTEF were included in this study. After a median follow-up of 31.4 (19.8, 48.7) months, GR occurred in 28 patients (33.7%). Among them, six patients with only weight for age Z score (WAZ) < -2SD, five patients with only height for age Z score (HAZ) < -2SD, and six patients with only BMI for age Z score (BAZ) < -2SD, while seven patients with both WAZ and HAZ < -2SD and four patients with both WAZ, HAZ and BAZ < -2SD. Multivariate logistic regression analysis showed that birth weight, anastomotic stricture and dysphagia after rTEF repair were independent risk factors with OR of 0.325 (0.119, 0.891), 4.396 (1.451, 13.324) and 5.341 (1.153, 24.752) for GR, respectively. CONCLUSIONS GR is a common complication after rTEF repair. Birth weight, anastomotic stricture and dysphagia after rTEF repair are independent risk factors affecting growth.
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Affiliation(s)
- Peize Wang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shen Yang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhi Yang
- Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China
| | - Siqi Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China. .,Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China.
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6
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Moinichen UI, Mikkelsen A, Faugli A, Morkrid L, IJsstelstijn H, Emblem R. Impaired motor performance in adolescents with esophageal atresia. J Pediatr Surg 2021; 56:1926-1931. [PMID: 33298324 DOI: 10.1016/j.jpedsurg.2020.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS The study prospectively assessed motor development from infancy to adolescence in patients with esophageal atresia (EA). METHODS At one year of age motor performance was evaluated with the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development, Second Edition (BSID-II), and as adolescents reevaluated with Motor Assessment Battery for Children, Second Edition (MABC-2). Associations to clinical factors were assessed. RESULTS 23 EA patients were followed from infancy to adolescence. The median total PDI score in infancy was 102 (56-118) and the corresponding mean z-score was -0.006 (SD 0.995) and not significantly different from the reference values (p = 0.48). The median total MABC-2 score in adolescence was 75 (32-93) and the corresponding mean z-score -0.43 (SD 0.998) which is significantly below normal (p = 0.03). Children with impaired motor function in adolescence underwent significantly more rethoracotomies than those with normal motor performance (p = 0.037); whereas the two groups did not differ with respect to other clinical characteristics. CONCLUSION From infancy to adolescence the motor performance in the group of EA patients deteriorated from within normal range to significantly impaired compared to reference values. Interdisciplinary follow-up programs from infancy to adolescence with close monitoring for motor function is necessary to detect motor impairments.
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Affiliation(s)
- Unn Inger Moinichen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway.
| | - Audun Mikkelsen
- Department of Paediatric Surgery, Oslo University Hospital, Postbox 4950 Nydalen, Oslo, Norway
| | - Anne Faugli
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Lars Morkrid
- University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Hanneke IJsstelstijn
- Intencive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 GD, Rotterdam, the Netherlands
| | - Ragnhild Emblem
- Department of Paediatric Surgery, Oslo University Hospital, Postbox 4950 Nydalen, Oslo, Norway; University of Oslo, Problemveien 7, 0315 Oslo, Norway
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7
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Roorda D, Königs M, Eeftinck Schattenkerk L, van der Steeg L, van Heurn E, Oosterlaan J. Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:635-642. [PMID: 34112720 PMCID: PMC8543204 DOI: 10.1136/archdischild-2021-322158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022]
Abstract
AIM Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. METHOD PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. RESULTS The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. INTERPRETATION This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.
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Affiliation(s)
- Daniëlle Roorda
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens Eeftinck Schattenkerk
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Lideke van der Steeg
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ernest van Heurn
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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8
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van Hoorn CE, ten Kate CA, Rietman AB, Toussaint-Duyster LCC, Stolker RJ, Wijnen RMH, de Graaff JC. Long-term neurodevelopment in children born with esophageal atresia: a systematic review. Dis Esophagus 2021; 34:6347567. [PMID: 34378009 PMCID: PMC8597907 DOI: 10.1093/dote/doab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/29/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. METHODS We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords 'esophageal atresia', 'long-term outcome', 'motor development', 'cognitive development', and 'neurodevelopment'. RESULTS The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. CONCLUSIONS Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.
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Affiliation(s)
- Camille E van Hoorn
- Address correspondence to: Camille E. van Hoorn, Erasmus Medical Centre-Sophia Children’s Hospital, Department of Anaesthesiology, Department of Paediatric Surgery, PO Box: 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 636400488;
| | - Chantal A ten Kate
- Department of Paediatric Surgery, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands
| | - Andre B Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands, and
| | - Leontien C C Toussaint-Duyster
- Department of Orthopaedics, Section of Physical Therapy, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anaesthesiology, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands
| | - Rene M H Wijnen
- Department of Paediatric Surgery, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Erasmus MC-Sophia Children’s Hospital University Medical Centre, Rotterdam, The Netherlands
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9
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Francesca B, Benedetta R, Andrea C, Annabella B, Simonetta G, Antonio Z, Pietro B, Lucia A. Neurodevelopmental outcome in infants with esophageal atresia: risk factors in the first year of life. Dis Esophagus 2021; 34:5952300. [PMID: 33140099 DOI: 10.1093/dote/doaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Data on neurodevelopmental outcomes of infants born with esophageal atresia (EA) are still scarce and controversial. The aims of our study were to evaluate motor and cognitive development during the first year of life, in patients operated on of EA and to investigate potential risk factors for motor and cognitive development both at 6 and 12 months. This is an observational prospective longitudinal study in a selected cohort of type C and D EA infants enrolled in our follow-up program from 2009 to 2017. In order to exclude possible confounding factors, the following exclusion criteria were applied: (i) gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g; (ii) genetic syndrome or chromosomal anomaly known to be associated with neurodevelopmental delay; (iii) neurologic disease; (iv) esophageal gap ≥three vertebral bodies. Patients were evaluated at 6 and 12 months of life (corrected age for infants with a gestational age of 32-37 weeks) with the Bayley Scales of Infant and Toddler Development-3rd Edition. In our selected cohort of EA infants, 82 were evaluated at 6 months and 59 were reevaluated at 12 months. Both Motor and Cognitive average scores were within the norm at both time points. However, we report increased number of infants with motor delay with time: 14% at 6 months and 24% at 12 months. Multiple regression analysis for Motor scores at 6 [F(4,74) = 4.363, P = 0.003] and 12 months [F(6,50) = 2.634, P = 0.027] identified (i) low birth weight, (ii) longer hospital stay and (iii) weight < fifth percentile at 1 year as risk factors. Interestingly, average Cognitive scores also increased with time from 85.2% at 6 months and 96.6% at 12 months. Multiple regression models explaining variance of Cognitive scores at 6 [F(4, 73) = 2.458, P = 0.053] and 12 months [F(6, 49) = 1.232, P = 0.306] were nonsignificant. Our selected cohort of EA patients shows, on the average, Motor and Cognitive scores within the norm both at 6 and 12 months. Nevertheless, the percentage of infants with Motor scores below the average increases regardless gestational age. None of clinical and sociodemographic variables taken into consideration was able to predict cognitive development both at 6 and 12 months whereas risk factors for Motor development change during the first year of life. Healthcare providers should pay particular attention to patients with low birth weight, longer hospital stays and weight under fifth percentile at 1 year. Future studies should include long-term outcomes to reveal possible catch up in motor development and/or possible findings in Cognitive scores.
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Affiliation(s)
- Bevilacqua Francesca
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Conforti Andrea
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Braguglia Annabella
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Gentile Simonetta
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Zaccara Antonio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bagolan Pietro
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Aite Lucia
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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10
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Traini I, Menzies J, Hughes J, Leach ST, Krishnan U. Oesophageal atresia: The growth gap. World J Gastroenterol 2020; 26:1262-1272. [PMID: 32256015 PMCID: PMC7109272 DOI: 10.3748/wjg.v26.i12.1262] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia (OA) repair. Few studies have specifically explored the reasons for growth impairment in this complex cohort. The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence, highlighting the need for early involvement of a dietitian and speech pathologist, and consideration of optimal medical reflux management prior to referring for anti-reflux surgery. However, it remains difficult to reach conclusions regarding other factors which may negatively influence growth, due to conflicting findings, inconsistent definitions and lack of validated tool utilisation. While swallowing and feeding difficulties are particularly frequent in younger children, their relationship with growth remains unclear. It is possible that these morbidities impact on the diet of children with OA, but detailed analysis of dietary composition and quality, and its relationship with these complications and growth, has not yet been conducted. Another potential area of research in OA is the role of the microbiota in growth and nutrition. While the microbiota has been linked to growth impairment in other paediatric conditions, it is yet to be investigated in OA. Further research is needed to identify the most important contributory factors to poor growth, the role of the intestinal microbiota, and effective interventions to maximise growth and nutritional outcomes in this cohort.
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Affiliation(s)
- Isabelle Traini
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Jennifer Hughes
- Department of Speech Pathology, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Steven Thomas Leach
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Usha Krishnan
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Paediatric Gastroenterology, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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11
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Batta V, Rao S, Wagh D, Tan JKG, Gollow I, Simmer K, Bulsara MK, Patole S. Early neurodevelopmental outcomes of congenital gastrointestinal surgical conditions: a single-centre retrospective study. BMJ Paediatr Open 2020; 4:e000736. [PMID: 32821861 PMCID: PMC7422631 DOI: 10.1136/bmjpo-2020-000736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evidence is emerging that surgery in the neonatal period is associated with increased risk of suboptimal neurodevelopmental outcomes (SNDO). The aim of this study was to describe neurodevelopmental outcomes (at 1 year) of neonatal surgery for congenital gastrointestinal surgical conditions (CGSC) and to explore risk factors. METHODS Retrospective study (2005-2014) of infants born ≥34 weeks gestation with CGSC and admitted to the surgical neonatal intensive care unit of Perth Children's Hospital, Western Australia. Clinical details and 1-year developmental outcomes based on Griffiths Mental Developmental Assessment Scales were collated from the database and by reviewing the medical records of study infants. SNDO was defined as one or more of the following: a general quotient less than 88 (ie, >1 SD below mean), cerebral palsy, blindness or sensorineural deafness. Univariable and multivariable logistic regression analyses were carried out to explore risk factors for SNDO. A total of 413 infants were included, of which 13 died. Median gestation was 37.6 weeks (IQR: 36.4-39.1). Information on developmental outcomes was available from 262 out of 400 survivors. A total of 43/262 (16.4%) had SNDO. On univariable analysis, lower z scores for birth weight, prolonged duration of antibiotics, increased episodes of general anaesthesia and prolonged duration of hospital stay were associated with SNDO. On multivariable analysis, lower z scores for birth weight and prolonged hospital stay were associated with increased risk of SNDO. CONCLUSIONS Late preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO. Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomes.
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Affiliation(s)
- Vamsi Batta
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Shripada Rao
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Deepika Wagh
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jason Khay Ghim Tan
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Ian Gollow
- Paediatric Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Karen Simmer
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Max K Bulsara
- Biostatistics, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Sanjay Patole
- Neonatal Directorate, Perth Children's Hospital and King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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12
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Clinical predictors and prevalence of receiving special preschool/school support in children with repaired esophageal atresia. J Pediatr Surg 2018; 53:1970-1975. [PMID: 29273218 DOI: 10.1016/j.jpedsurg.2017.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND/PURPOSE In a sparsely investigated field, we aimed to evaluate the use of special preschool/school support among children with repaired esophageal atresia (EA) and/or tracheoesophageal fistula (TEF), the predicting clinical factors for this support, and level of school absence. METHODS Data on 119 EA/TEF children 2-17years old were collected through medical records and questionnaires (response rate 95%). Logistical regression analysis identified clinical predictors of special preschool/school support in the population without genetic disorders (n=105). Nominal hypothesis testing was performed using Fisher's exact test (p<0.05). RESULTS Of the 119 children, 35.3% received special preschool/school support; 26.8% educational support, 21.8% support with nutritional intake issues and 13.4% received both types of support. Educational support was independently predicted by birth weight<2500g (p=0.026) and associated anomalies (p=0.049), nutritional intake support by gastrostomy insertion (p=0.0028), and both types of supports by major revisional surgery (p=0.0081). School absence ≥1month/year, present in 25.5% of the children, was more frequently reported in children receiving preschool/school support, in preschoolers and in those with persistent respiratory problems (p<0.05). CONCLUSIONS Special preschool/school support is provided for approximately one-third of EA/TEF children. In EA/TEF children without genetic disorders, use of this support is predicted by congenital and surgical factors, and related to frequent school absence.
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13
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Miranda A, Roque S, Serre-Miranda C, Pêgo JM, Correia-Pinto J. Inflammatory response and long-term behavioral assessment after neonatal CO 2-pneumothorax: study in a rodent model. J Pediatr Surg 2018; 53:1318-1325. [PMID: 28916046 DOI: 10.1016/j.jpedsurg.2017.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Carbon-dioxide (CO2)-pneumothorax during minimally invasive surgery induces well-known metabolic changes. However, little is known about its impact on the central nervous system. The aim of this work is to evaluate the acute impact of CO2-pneumothorax over central cytokine response and its long-term effect on animal behavior. METHODS This is an experimental study where neonatal Sprague-Dawley rats are submitted to CO2-pneumothorax. Peripheral and central cytokine response was evaluated 24h after insufflation, and peripheral immune cell phenotyping was evaluated 24h and 4weeks post-insufflation. Progenitor cell survival was evaluated in the hippocampal dentate gyrus, and the behavioral analysis was performed in adulthood to test cognition, anxious-like, and depressive-like behavior. RESULTS Significantly increased IL-10 levels were observed in the cerebrospinal-fluid (CSF) of animals submitted to CO2-pneumothorax, while no differences were found in serum. Regarding pro-inflammatory cytokines, no differences were observed in the periphery or centrally. CO2-pneumothorax event did not alter the survival of newborn cells in the hippocampal dentate gyrus, and no impact on long-term behavior was observed. CONCLUSIONS Neonatal animals submitted to CO2-pneumothorax present acutely increased CSF IL-10 levels. The CO2-pneumothorax seems to result in no significant outcome over neurodevelopment as no functional behavioral alterations were observed in adulthood.
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Affiliation(s)
- Alice Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Roque
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Cláudia Serre-Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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14
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Powell L, Frawley J, Crameri J, Teague WJ, Frawley GP. Oesophageal atresia: Are "long gap" patients at greater anesthetic risk? Paediatr Anaesth 2018; 28:249-256. [PMID: 29399924 DOI: 10.1111/pan.13336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long gap oesophageal atresia occurs in approximately 10% of all oesophageal atresia infants and surgical repair is often difficult with significant postoperative complications. Our aim was to describe the perioperative course, morbidity, and early results following repair of long gap oesophageal atresia and to identify factors which may be associated with complications. METHODS This is a single center retrospective cohort study of consecutive patients with oesophageal atresia undergoing surgical repair at The Royal Children's Hospital Melbourne from January 2006 to June 2017. RESULTS Two hundred and thirty-nine consecutive oesophageal atresia infants included 44 long gap oesophageal atresia infants and 195 non-long gap infants. A high rate of prematurity (24.7%), major cardiac (17%), and other surgically relevant malformations (12.6%) was found in both groups. The median age at oesophageal anastomosis surgery was 65.5 days for the long gap group vs 1 day for the oesophageal atresia group (mean difference 56.8 days, 95% CI 48.1-65.5 days, P < .01). Surgery for long gap oesophageal atresia included immediate primary anastomosis (n = 10), delayed primary anastomosis (n = 11), oesophageal lengthening techniques (n = 12) and primary oesophageal replacement (n = 6). Long gap oesophageal atresia was not associated with an increased incidence of difficult intubation (OR 2.8, 95% CI 0.6-22.1, P = .17), intraoperative hypoxemia (OR 1.6, 95% CI 0.6-4.5, P = .32), or hypotension (OR 0.9, 95% CI 0.5-1.8, P = .81). The surgical duration (177.7 vs 202.1 minute, mean difference [95% CI], 28 [5.5-50.4 minutes], P = .04) and mean duration of postoperative mechanical ventilation (107 vs 199.8 hours, mean difference [95% CI], 91.8 [34.5-149.1 hours], P < .01) were shorter for the non-long gap group. Overall in-hospital mortality was 7.5% (15.9% long gap vs 5.6% non-long gap oesophageal atresia OR 1.1, 95% CI 0.4-3.4, P = .85). CONCLUSION Long gap oesophageal atresia infants have a similar incidence of perioperative complications to other infants with oesophageal atresia. Current surgical approaches to long gap repair, however, are associated with longer anesthetic exposures and require multiple procedures in infancy to achieve oesophageal continuity.
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Affiliation(s)
- Laura Powell
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Jacinta Frawley
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Joe Crameri
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Geoff P Frawley
- Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Critical Care and Neuroscience Group, Murdoch Children's Research institute, Melbourne, Vic., Australia
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15
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Prediction of three year outcomes using the Bayley-III for surgical, cardiac and healthy Australian infants at one year of age. Early Hum Dev 2018; 117:57-61. [PMID: 29288912 DOI: 10.1016/j.earlhumdev.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/04/2017] [Accepted: 12/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous predictive research has predominantly focussed on infants who are preterm, low birth weight, who have a specific condition or who have undergone a specific procedure. AIM This study investigated the ability of outcomes at one year of age to predict outcomes at three years using the Bayley-III for infants who have undergone early major cardiac surgery (CS) or non-cardiac (NC) surgery and their healthy peers. STUDY DESIGN Participants who were part of the Development After Infant Surgery (DAISy) study who had complete Bayley-III assessments at one and three years of age were included in the analyses. This included 103 infants who had undergone CS, 158 who had NC surgery and 160 controls. RESULTS Bayley-III outcomes at one, although statistically significantly associated with three year outcomes in all domains were weak predictors of those outcomes for CS, NC surgical and healthy infants. Specificity for three year outcomes was good for cognitive, receptive language and fine motor domains for infants who had undergone CS and NC surgery. Sensitivity for <-1 SD at three years was poor for cognitive, expressive and receptive language, and fine motor outcomes for CS and NC surgical participants. CONCLUSION It remains difficult to predict how performance at one year on the Bayley-IIII predicts performance at three on the Bayley-III for infants who have undergone early major CS or NC surgery and for healthy Australian infants.
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16
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Evaluation of developmental prognosis for esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int 2017; 33:1091-1095. [PMID: 28803355 DOI: 10.1007/s00383-017-4142-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This study investigated risk factors for developmental disorders after the repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). METHODS The clinical charts of all infants with EA/TEF (gross type C) treated at our institution between 1993 and 2013 were analyzed. Patients with chromosomal aberrations were excluded. Forty-seven patients were divided into groups according to the presence (D) or absence (N) of developmental disorders. Patients were assessed with appropriate developmental examinations at age >3 years. RESULTS Group D comprised 13 patients. The 34 patients in the group N had received a standard education. In groups D and N, gestational age was 36.5 versus 38.5 weeks, birth weight was 1808 versus 2662 g, and congenital cardiac anomalies occurred in 76.9 versus 23.5%. These differences reached significance. Operative data did not differ significantly. Overall complications occurred in 69.2 versus 29.4%, gastroesophageal reflux (GER) requiring fundoplication in 46.1 versus 8.8%, and oral ingestion difficulty in 61.5 versus 14.7%, which were significantly different. The frequencies of anastomotic leakage, anastomotic stricture, and recurrent fistula did not differ significantly. CONCLUSION Gestation, birth weight, and cardiac anomalies could be risk factors for developmental disorders. Moreover, overall complications, GER, and oral ingestion may affect development.
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17
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Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia: A Phenomenological Inquiry. Adv Neonatal Care 2017; 17:313-323. [PMID: 28570293 DOI: 10.1097/anc.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant. PURPOSE The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair. METHODS A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes. RESULTS The essence that conceptualized the study was "making connections: day-by-day." Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community. IMPLICATIONS FOR PRACTICE Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions. IMPLICATIONS FOR RESEARCH Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.
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18
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Stolwijk LJ, van der Zee DC, Tytgat S, van der Werff D, Benders MJNL, van Herwaarden MYA, Lemmers PMA. Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia. World J Surg 2017; 41:1384-1392. [PMID: 28058473 PMCID: PMC5394154 DOI: 10.1007/s00268-016-3853-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elongation and repair of long gap esophageal atresia (LGEA) can be performed thoracoscopically, even directly after birth. The effect of thoracoscopic CO2-insufflation on cerebral oxygenation (rScO2) during the consecutive thoracoscopic procedures in repair of LGEA was evaluated. METHODS Prospective case series of five infants, with in total 16 repetitive thoracoscopic procedures. A CO2-pneumothorax was installed with a pressure of maximum 5 mmHg and flow of 1 L/min. Parameters influencing rScO2 were monitored. For analysis 10 time periods of 10' during surgery and in the perioperative period were selected. RESULTS Median gestational age was 35+3 [range 33+4 to 39+6] weeks; postnatal age at time of first procedure 4 [2-53] days and time of insufflation 127[22-425] min. Median rScO2 varied between 55 and 90%. Transient outliers in cerebral oxygenation were observed in three patients. In Patient 2 oxygenation values below 55% occurred during a low MABP and Hb < 6 mmol/L. The rScO2 increased after erythrocytes transfusion. Patient 5 also showed a rScO2 of 50% with a Hb <6 mmol/L during all procedures, except for a substantial increase during a high paCO2 of 60 mmHg. Patient 4 had a rScO2 > 85% during the first procedure with a concomitant high FiO2 > 45%. All parameters recovered during the surgical course. CONCLUSIONS This prospective case series of NIRS during consecutive thoracoscopic repair of LGEA showed that cerebral oxygenation remained stable. Transient outliers in rScO2 occurred during changes in hemodynamic or respiratory parameters and normalized after interventions of the anesthesiologist. This study underlines the importance of perioperative neuromonitoring and the close collaboration between pediatric surgeon, anesthesiologist and neonatologist.
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Affiliation(s)
- Lisanne J Stolwijk
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefaan Tytgat
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Desiree van der Werff
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maud Y A van Herwaarden
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Harmsen WJ, Aarsen FJ, van der Cammen-van Zijp MHM, van Rosmalen JM, Wijnen RMH, Tibboel D, IJsselstijn H. Developmental problems in patients with oesophageal atresia: a longitudinal follow-up study. Arch Dis Child Fetal Neonatal Ed 2017; 102:F214-F219. [PMID: 27582496 DOI: 10.1136/archdischild-2015-309976] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To longitudinally evaluate motor development and predictive factors in school-age children with oesophageal atresia. DESIGN Cohort study with prospective longitudinal follow-up. SETTING Outpatient clinic of a tertiary university paediatric hospital. PATIENTS Children with oesophageal atresia born between January 1999 and May 2006 were assessed at 5 and 8 years of age. INTERVENTIONS None. MAIN OUTCOME Motor performance was evaluated at 5 and 8 years using the Movement Assessment Battery for Children (M-ABC). Additionally, we evaluated perinatal characteristics, duration of anaesthesia within the first 24 months, socioeconomic status, sports participation and school performance at time of follow-up and intelligence and sustained attention at the age of 8 years. RESULTS In 5-year-olds (n=54), the mean (SD) z-score M-ABC was slightly, but significantly lower than age-predicted normative values (-0.75 (0.83), p<0.001). In 8-year-olds (n=49), the z-score M-ABC was -0.53 (0.91) (p<0.001), intelligence was normal, but sustained attention was impaired: z-score speed (-1.50 (1.73)) and raw score attentional fluctuation (3.99 (1.90)) (both p<0.001). Motor problems mainly concerned gross motor performance. Duration of anaesthesia and sustained attention were negatively associated with motor development; sports participation was positively associated. CONCLUSIONS Longer duration of anaesthesia and sustained attention problems were associated with gross motor problems in school-age patients with oesophageal atresia. Parental awareness of risks for motor problems may provide the opportunity to offer timely intervention.
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Affiliation(s)
- Wouter J Harmsen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Femke J Aarsen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | - Rene M H Wijnen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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20
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Roberts K, Karpelowsky J, Fitzgerald DA, Soundappan SS. Outcomes of oesophageal atresia and tracheo-oesophageal fistula repair. J Paediatr Child Health 2016; 52:694-8. [PMID: 27206060 DOI: 10.1111/jpc.13211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/31/2022]
Abstract
Oesophageal atresia and tracheo-oesophageal fistula are congenital anomalies of the oesophagus requiring surgical repair in infancy, either by open or thoracoscopic approach. Although mortality rates associated with this procedure are low, children may go on to have complications throughout childhood and into adulthood, most commonly related to ongoing gastrointestinal and respiratory symptoms. This review outlines the early, mid and long-term outcomes for these children in terms of quality of life and incidence of symptoms.
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Affiliation(s)
- Kiera Roberts
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Karpelowsky
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, The Children's Hospital Westmead, Sydney, New South Wales, Australia
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21
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Walker K, Loughran-Fowlds A, Halliday R, Badawi N, Stewart J, Holland AJA. Developmental outcomes at three years of age of infants with esophageal atresia. J Pediatr Surg 2016; 51:249-51. [PMID: 26653948 DOI: 10.1016/j.jpedsurg.2015.10.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/AIMS Previous work assessing early developmental outcomes of infants at one year of age following surgery for esophageal atresia (OA) and/or tracheoesophageal fistula (TOF) found a significantly lower score in expressive language compared with control infants. The purpose of this study was to determine whether these differences were still evident at three years of age. METHODS Between August 2006 and July 2008, infants who required surgical correction of OA/TOF were prospectively enrolled as part of a large study which examined developmental outcomes following surgery. Patients were reassessed using the Bayley Scales of Infant and Toddler Development Version III. Cognition, expressive and receptive language, fine motor and gross motor skills scores were compared with both the standardized norms and also with contemporaneous control infants. RESULTS 24 of the 31 infants (77%) assessed at one year were reassessed at three years of age. There was no significant difference between the Bayley scores of the infants with OA/TOF and the standardized norms of the tests in four of the subsets: cognition, expressive language, fine and gross motor skills. Infants with OA scored higher than normative values for the receptive language subscale (P=0.001). When compared with the controls, there were no significant differences in any of the subscales. CONCLUSION Compared with the outcomes at one year, infants with OA/TOF have improved and were scoring within the normal range for the assessment at three years. This may in part be because of the early intervention services which many of these children were provided.
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Affiliation(s)
- Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia; Cerebral Palsy Alliance, Sydney, Australia
| | - Jan Stewart
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Andrew J A Holland
- Sydney Medical School, The University of Sydney, Australia; Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia.
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22
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Stolwijk LJ, Lemmers PM, Harmsen M, Groenendaal F, de Vries LS, van der Zee DC, Benders MJN, van Herwaarden-Lindeboom MYA. Neurodevelopmental Outcomes After Neonatal Surgery for Major Noncardiac Anomalies. Pediatrics 2016; 137:e20151728. [PMID: 26759411 DOI: 10.1542/peds.2015-1728] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Increasing concerns have been raised about the incidence of neurodevelopmental delay in children with noncardiac congenital anomalies (NCCA) requiring neonatal surgery. OBJECTIVE This study aimed to determine the incidence and potential risk factors for developmental delay after neonatal surgery for major NCCA. DATA SOURCES A systematic search in PubMed, Embase and the Cochrane Library was performed through March 2015. STUDY SELECTION Original research articles on standardized cognitive or motor skills tests. DATA EXTRACTION Data on neurodevelopmental outcome, the Bayley Scales of Infant Development, and risk factors for delay were extracted. RESULTS In total, 23 eligible studies were included, reporting on 895 children. Meta-analysis was performed with data of 511 children, assessed by the Bayley Scales of Infant Development at 12 and 24 months of age. Delay in cognitive development was reported in a median of 23% (3%-56%). Meta-analysis showed a cognitive score of 0.5 SD below the population average (Mental Development Index 92 ± 13, mean ± SD; P < .001). Motor development was delayed in 25% (0%-77%). Meta-analysis showed a motor score of 0.6 SD below average (Psychomotor Development Index 91 ± 14; P < .001). Several of these studies report risk factors for psychomotor delay, including low birth weight, a higher number of congenital anomalies, duration of hospital admission, and repeated surgery. LIMITATIONS All data were retrieved from studies with small sample sizes and various congenital anomalies using different neurodevelopmental assessment tools. CONCLUSIONS Cognitive and motor developmental delay was found in 23% of patients with NCCA. Meta-analysis showed that the mean neurodevelopmental outcome scores were 0.5 SD below the normative score of the healthy population.
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Affiliation(s)
- Lisanne J Stolwijk
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
| | - Petra Ma Lemmers
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Marissa Harmsen
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Floris Groenendaal
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Linda S de Vries
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
| | - David C van der Zee
- Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands
| | - Manon J N Benders
- Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands Brain Center Rudolf Magnus, University Medical Center, Utrecht
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