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Chen X, Pereira N, Ciecierega T, Graw-Panzer K, Maresh AM. Aerodigestive evaluation of pediatric patients with chronic aspiration. Int J Pediatr Otorhinolaryngol 2024; 182:112028. [PMID: 38981299 DOI: 10.1016/j.ijporl.2024.112028] [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: 05/04/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of coordinated endoscopy with otolaryngology, pulmonology, and gastroenterology in diagnosing and managing chronic aspiration in pediatric patients. METHODS We reviewed our REDCap Pediatric Aerodigestive Database for patients with chronic aspiration who underwent coordinated endoscopy between January 2013 and July 2023. Patient demographics, comorbidities, operative findings, interventions, and outcomes were reviewed. RESULTS Forty-nine patients were identified with a diagnosis of aspiration. Their mean (SD) age was 28 (36) months (range 1.2-163 months) with more than half of the patients younger than 24 months. The most common findings noted on combined endoscopies were laryngeal cleft (n = 30), positive bacterial culture (n = 18), positive viral PCR (n = 17), and active reflux-induced esophagitis/gastritis (n = 9). Patients with a positive bacterial culture were associated with a history of recurrent pneumonia (p = 0.009). There were no other significant associations between endoscopy findings and patient demographics, co-morbidities, or symptoms. Twenty-five (51 %) had multiple abnormalities identified by at least 2 different specialists at the time of endoscopy and 6 patients (12 %) had abnormalities across all three specialists. CONCLUSION Coordinated endoscopy should be considered in pediatric patients presenting with aspiration on MBS or non-specific symptoms suggestive for chronic aspiration for comprehensive diagnosis and management.
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Affiliation(s)
- Xiaoxuan Chen
- Department of Otolaryngology-Head and Neck Surgery, and MD Program, Weill Cornell Medicine, New York, USA
| | - Nicola Pereira
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Weill Cornell Medicine, New York, USA
| | - Thomas Ciecierega
- Department of Pediatrics, Pediatric Gastroenterology, Weill Cornell Medicine, New York, USA
| | - Katharina Graw-Panzer
- Department of Pediatrics, Pediatric Pulmonology, Weill Cornell Medicine, New York, USA
| | - Alison M Maresh
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Weill Cornell Medicine, New York, USA.
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Zgardau A, Hathi K, Fowler J, Mullowney T, Price A, Husein M, Graham ME, Dzioba A, Madou E, Strychowsky JE. Carbon Footprint Reduction Associated With Multidisciplinary Pediatric Airway Clinics: A Program Evaluation Study. OTO Open 2024; 8:e167. [PMID: 38974174 PMCID: PMC11222738 DOI: 10.1002/oto2.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Health care is a significant contributor to the climate crisis. Multidisciplinary clinics (MDC) may reduce carbon emissions by combining multiple appointments into one. This is the first program evaluation study to quantify the carbon footprint associated with multidisciplinary pediatric airway clinics. Study Design Retrospective. Setting Children's Hospital at London Health Sciences Center, London, Canada. Methods Pediatric airway MDC allows patients to see otolaryngology and respirology in one appointment. The carbon and financial savings (Canadian Dollars) of all patients attending the MDC from January 1, 2018 to December 31, 2022 were calculated. Patient postal codes and institutional parking rates were inputted into the CASCADES carbon accounting tool. Total distance was divided into unsustainable (vehicles) and sustainable (transit, walking, cycling) transportation to calculate carbon emissions. Travel costs included cost/kilometer for vehicles (maintenance, license/registration, insurance, fuel) and costs/ride for transit. Results A total of 560 MDC appointments for 300 patients saved 77,785 km. Total carbon emissions saved from travel averted was 16.21 tonnes. The total carbon emissions saved, minus public transit, was 15.60 tonnes. Using the Natural Resources Canada Greenhouse Gas Equivalencies Calculator, 16.21 tonnes are approximately equivalent to 5 passenger vehicles, 6906 L of gasoline, 3.8 homes' energy, and 10.8 homes' electricity use for one year, 36.6 barrels of oil consumed, and 675 propane cylinders. Travel costs of $28,891.83 (no parking), $30,519.40 ($4 minimum parking fee), or $33,774.55 ($12 maximum parking fee) were saved. Conclusion MDC effectively reduced carbon emissions and offered patients financial savings. Similar models can be adapted across institutions to help mitigate climate change.
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Affiliation(s)
- Alina Zgardau
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Kalpesh Hathi
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - James Fowler
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Tara Mullowney
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - April Price
- Department of Pediatrics, Division of RespirologyWestern UniversityLondonOntarioCanada
| | - Murad Husein
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - M. Elise Graham
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonOntarioCanada
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Lee S, Ko A, Park S, Kim KW, Ihn K, Ho IG, Kim SH, Kim HD, Lee JS, Kang HC. Efficacy of enteral feeding by gastrostomy tube placement in patients with Lennox-Gastaut syndrome on body weight and days of hospitalization: A retrospective case series. Nutr Clin Pract 2024. [PMID: 39030737 DOI: 10.1002/ncp.11177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy that begins during childhood and frequently leads to significant neurological impairments. Patients with LGS are likely to receive improper oral nutrition because of issues such as dysphagia and aspiration risk, potentially resulting in long-term tube feeding and eventual gastrostomy tube placement. Therefore, we investigated the effects of gastrostomy tube placement on nutrition outcomes and frequency of hospitalization in LGS. METHODS We retrospectively examined 67 patients diagnosed with LGS who had undergone gastrostomy tube placement between January 2005 and August 2022. Comprehensive clinical data and complications arising from the procedure were collected. Patients' nutrition condition and frequency of hospitalizations were analyzed before and after gastrostomy tube placement. RESULTS Gastrostomy tube placement was performed for the following reasons: high risk of aspiration (50 out of 67, 74.6%), dysphagia (13 out of 67, 25.4%), persistent nasogastric tube feeding (2 out of 67, 3.0%), and severe malnutrition (2 out of 67, 3.0%). After the procedure, z scores for weight-for-age improved significantly, shifting from -3.35 ± 3.57 to -2.54 ± 2.70 over a 2-year interval (P < 0.001). Additionally, the total days of hospitalization and days of hospitalization due to respiratory symptoms reduced significantly from 41.94 ± 51.76 to 15.27 ± 26.68 (P < 0.001) and from 23.75 ± 36.92 to 10.52 ± 22.98 (P = 0.009), respectively. Among the patients, 50 (74.6%) experienced complications resulting from gastrostomy, with a relatively small proportion of major complications (11 out of 67, 16.4%) and no mortality. CONCLUSION Gastrostomy tube placement is a relatively safe procedure with favorable effects on nutrition status and hospitalization rates in patients with LGS.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ara Ko
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sowon Park
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyong Ihn
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Geol Ho
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lefton-Greif MA, Arvedson JC, Farneti D, Levy DS, Jadcherla SR. Global State of the Art and Science of Childhood Dysphagia: Similarities and Disparities in Burden. Dysphagia 2024:10.1007/s00455-024-10683-5. [PMID: 38503935 DOI: 10.1007/s00455-024-10683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
Feeding/swallowing and airway protection are complex functions, essential for survival, and continue to evolve throughout the lifetime. Medical and surgical advances across the globe have improved the long-term survival of medically complex children at the cost of increasing comorbidities, including dysfunctional swallowing (dysphagia). Dysphagia is prominent in children with histories of preterm birth, neurologic and neuromuscular diagnoses, developmental delays, and aerodigestive disorders; and is associated with medical, health, and neurodevelopmental problems; and long-term socioeconomic, caregiver, health system, and social burdens. Despite these survival and population trends, data on global prevalence of childhood dysphagia and associated burdens are limited, and practice variations are common. This article reviews current global population and resource-dependent influences on current trends for children with dysphagia, disparities in the availability and access to specialized multidisciplinary care, and potential impacts on burdens. A patient example will illustrate some questions to be considered and decision-making options in relation to age and development, availability and accessibility to resources, as well as diverse cultures and family values. Precise recognition of feeding/swallowing disorders and follow-up intervention are enhanced by awareness and knowledge of global disparities in resources. Initiatives are needed, which address geographic and economic barriers to providing optimal care to children with dysphagia.
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Affiliation(s)
- Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
- Departments of Pediatrics, Otolaryngology-Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Joan C Arvedson
- Department of Speech-Language Pathology, Children's Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniele Farneti
- Audiologic Phoniatric Service, ENT Department AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Deborah S Levy
- Department of Health and Human Communication, Universidade Federal, do Rio Grande do Sul, Brazil
- Department of Speech Pathology and Audiology, Hospital de Clínicas, de Porto Alegre, Brazil
- Multi-Professional Residency Program, Hospital de Clínicas, de Porto Alegre, Brazil
| | - Sudarshan R Jadcherla
- Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Pottorff A, Liu E, Du M, Catacora A, Rosen R, McSweeney M. Assessment of families' experience with care integration within an aerodigestive program. J Pediatr Gastroenterol Nutr 2024; 78:223-230. [PMID: 38374563 DOI: 10.1002/jpn3.12108] [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] [Received: 05/21/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The objective of this study was to assess if enrollment in a pediatric multidisciplinary aerodigestive program significantly impacted families' experiences with care integration. METHODS A previously validated 48-question Pediatric Integrated Care Survey (PICS) was administered in a cross-sectional manner to both new (new-ADC) and established (est-ADC) patients presenting for an outpatient Aerodigestive Center visit at Boston Children's Hospital. Survey results were grouped into the following five care coordination domains: (1) access to care, (2) care goal creation/planning, (3) family impact, (4) communication with health care providers, and (5) team functioning. Families were asked to rate their care integration experiences in the prior 12 months using yes/no and Likert-based questions. Comparisons were analyzed using logistic regression. Factor analysis was also performed. RESULTS Ninety patient families were surveyed: 54 (60%) est-ADC patients and 36 (40%) new-ADC patients. Est-ADC patients reported higher levels of experience with team functioning, provider awareness of prior testing, provider communication, and access to alternative methods of communication. Self-identified non-White patients reported lower satisfaction in team functioning and provider understanding of their child's long-term care plan. No significant differences in care integration experiences before and after the onset of the coronavirus pandemic were seen. CONCLUSIONS Patients enrolled in aerodigestive centers experienced improved care integration, most significantly in provider communication and team functioning. Despite these improvements, self-identified non-White families reported a lower care integration experience.
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Affiliation(s)
- Alexandra Pottorff
- Division of Gastroenterology, Hepatology and Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maritha Du
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrea Catacora
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maireade McSweeney
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Pazinatto DB, Brandão MAB, Costa FLP, Maunsell R. Initial evaluation of a multidisciplinary pediatric aerodigestive program in a Brazilian hospital: challenges and mitigation strategies. J Pediatr (Rio J) 2023; 99:626-634. [PMID: 37414098 PMCID: PMC10594015 DOI: 10.1016/j.jped.2023.05.012] [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: 03/11/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To identify clinical and epidemiological characteristics of children evaluated by the pediatric aerodigestive program at the beginning of its activity, describe challenges in follow-up, and suggest mitigation strategies. METHODS A case series was conducted describing the first 25 patients discussed by the aerodigestive team from a Brazilian quaternary public university hospital between April 2019 and October 2020. The median follow-up was 37 months. RESULTS During the study period 25 children were seen by the group and the median age at first assessment was 45.7 months old. Eight children had a primary airway abnormality, five had a tracheostomy. Nine children had genetic disorders and one had esophageal atresia. Dysphagia was present in 80% of the patients, 68% had a history of chronic or recurrent lung disease, 64% had a gastroenterological diagnosis and 56% had neurological impairment. Moderate to severe dysphagia was identified in 12 children and 7 of these had an exclusive oral diet at the time. The majority of children (72%) had 3 or more comorbidities. Following team discussion, a change in feeding strategy was suggested in 56% of the children. The most frequently ordered exam was pHmetry (44%) and gastrostomy was the surgical procedure with the longest waiting list. CONCLUSIONS Dysphagia was the most frequent issue encountered in this initial group of aerodigestive patients. Pediatricians caring for these children must be involved in aerodigestive team discussions and hospital policies must be revised to facilitate access to exams and procedures needed for this population.
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Affiliation(s)
| | | | | | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Kaul I, Chiou EH. The Role of Pediatric Gastroenterologists in the Evaluation of Complex Aerodigestive Disorders. Curr Gastroenterol Rep 2022; 24:211-221. [PMID: 36401684 DOI: 10.1007/s11894-022-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE OF REVIEW Children with aerodigestive disorders frequently have concerns regarding difficulty breathing, swallowing, and growing. In this review, we explored the role of pediatric gastroenterologists in the evaluation of complex aerodigestive disorders and the overall approach to these often-challenging patients. RECENT FINDINGS Pediatric gastroenterologists evaluate children with aerodigestive concerns ranging from dysphagia and gastroesophageal reflux to complex congenital abnormalities such as esophageal atresia. Diagnostic tools, such as multichannel intraluminal impedance-pH monitoring, are used for diagnosing gastroesophageal reflux and assessing the correlation with symptoms. Endoscopic evaluation, and in some complex cases, with therapeutic dilations may also be performed. Gastrointestinal dysmotility evaluation with manometry studies are also being increasingly utilized. Multidisciplinary aerodigestive programs can provide a coordinated approach to children with complex airway, pulmonary and gastrointestinal tract disorders. A pediatric gastroenterologist's expertise and specialized skills not only offer many diagnostic tools for these complicated medical cases but are also important in long term medical management.
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Affiliation(s)
- Isha Kaul
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA
| | - Eric H Chiou
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA.
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Kanotra SP, Weiner R, Rahhal R. Making the case for multidisciplinary pediatric aerodigestive programs. World J Gastroenterol 2022; 28:3620-3626. [PMID: 36161050 PMCID: PMC9372800 DOI: 10.3748/wjg.v28.i28.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/23/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Multidisciplinary pediatric aerodigestive centers have been proposed to address the needs of children with complex multi-system problems affecting the respiratory and upper gastrointestinal tracts. The setup of a multidisciplinary service allows for the complex coordination needed between different subspecialties. This allows for rapid communication and family-centered decision making and agreement on further diagnostic and/or therapeutic next steps such as offering triple endoscopy when indicated. Triple endoscopy entails performing rigid upper airway assessment, flexible bronchoscopy and upper gastrointestinal endoscopy and has been linked to reduced time to diagnosis/treatment, reduced costs and anesthesia exposure. This review summarizes the available literature on the structure and benefits of multidisciplinary pediatric aerodigestive services.
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Affiliation(s)
- Sohit P Kanotra
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Rebecca Weiner
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Iowa, Iowa City, IA 52242, United States
| | - Riad Rahhal
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Iowa, Iowa City, IA 52242, United States
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