Respiratory problems in children with esophageal atresia and tracheoesophageal fistula

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Abstract

Background: Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The aim of this study is to describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient's needs and harmonize the care. Methods: A retrospective data collection was performed on 105 children with EA and TEF followed at Department of Pediatric Medicine of Bambino Gesù Children's Hospital (Rome, Italy) between 2010 and 2015. Results: 69/105 (66%) children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years and only 63/69 (91%) performed specialist assessment at Respiratory Unit. Recurrent pneumonia (33%) and wheezing (31%) were the most reported symptoms. The first respiratory evaluation was performed after surgically correction of gastroesophageal reflux (GER) at mean age of 3.9 ± 4.2 years. Twenty nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41%), residual tracheal diverticulum (34%), bronchiectasis (31%), tracheal vascular compression (21%), tracheomalacia (17%) and esophageal diverticulum (14%). Fifty three patients have undergone to airways endoscopy detecting tracheomalacia (66%), residual tracheal diverticulum (26%), recurrent tracheoesophageal fistula (19%) and vocal cord paralysis (11%). Conclusions: Our study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work up must be considered.

Original languageEnglish
Article number77
JournalItalian Journal of Pediatrics
Volume43
Issue number1
DOIs
Publication statusPublished - Sep 5 2017

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Tracheomalacia
Diverticulum
Respiratory Sounds
Gastroesophageal Reflux
Pneumonia
Esophageal Diverticulum
Tracheoesophageal Fistula
Vocal Cord Paralysis
Bronchiectasis
Pulmonary Atelectasis
Age of Onset
Cough
Italy
Endoscopy
Blood Vessels
Thorax
Medicine
Esophageal atresia with or without tracheoesophageal fistula
Pediatrics
Therapeutics

Keywords

  • Congenital malformations
  • Esophageal atresia
  • Flexible bronchoscopy
  • Respiratory symptoms
  • Tracheoesophageal fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{fe094094c8e247128a94629d870e848e,
title = "Respiratory problems in children with esophageal atresia and tracheoesophageal fistula",
abstract = "Background: Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The aim of this study is to describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient's needs and harmonize the care. Methods: A retrospective data collection was performed on 105 children with EA and TEF followed at Department of Pediatric Medicine of Bambino Ges{\`u} Children's Hospital (Rome, Italy) between 2010 and 2015. Results: 69/105 (66{\%}) children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years and only 63/69 (91{\%}) performed specialist assessment at Respiratory Unit. Recurrent pneumonia (33{\%}) and wheezing (31{\%}) were the most reported symptoms. The first respiratory evaluation was performed after surgically correction of gastroesophageal reflux (GER) at mean age of 3.9 ± 4.2 years. Twenty nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41{\%}), residual tracheal diverticulum (34{\%}), bronchiectasis (31{\%}), tracheal vascular compression (21{\%}), tracheomalacia (17{\%}) and esophageal diverticulum (14{\%}). Fifty three patients have undergone to airways endoscopy detecting tracheomalacia (66{\%}), residual tracheal diverticulum (26{\%}), recurrent tracheoesophageal fistula (19{\%}) and vocal cord paralysis (11{\%}). Conclusions: Our study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work up must be considered.",
keywords = "Congenital malformations, Esophageal atresia, Flexible bronchoscopy, Respiratory symptoms, Tracheoesophageal fistula",
author = "Federica Porcaro and Laura Valfr{\'e} and Aufiero, {Lelia Rotondi} and Luigi Dall'Oglio and {De Angelis}, Paola and Alberto Villani and Pietro Bagolan and Sergio Bottero and Renato Cutrera",
year = "2017",
month = "9",
day = "5",
doi = "10.1186/s13052-017-0396-2",
language = "English",
volume = "43",
journal = "Italian Journal of Pediatrics",
issn = "1720-8424",
publisher = "BioMed Central Ltd.",
number = "1",

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TY - JOUR

T1 - Respiratory problems in children with esophageal atresia and tracheoesophageal fistula

AU - Porcaro, Federica

AU - Valfré, Laura

AU - Aufiero, Lelia Rotondi

AU - Dall'Oglio, Luigi

AU - De Angelis, Paola

AU - Villani, Alberto

AU - Bagolan, Pietro

AU - Bottero, Sergio

AU - Cutrera, Renato

PY - 2017/9/5

Y1 - 2017/9/5

N2 - Background: Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The aim of this study is to describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient's needs and harmonize the care. Methods: A retrospective data collection was performed on 105 children with EA and TEF followed at Department of Pediatric Medicine of Bambino Gesù Children's Hospital (Rome, Italy) between 2010 and 2015. Results: 69/105 (66%) children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years and only 63/69 (91%) performed specialist assessment at Respiratory Unit. Recurrent pneumonia (33%) and wheezing (31%) were the most reported symptoms. The first respiratory evaluation was performed after surgically correction of gastroesophageal reflux (GER) at mean age of 3.9 ± 4.2 years. Twenty nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41%), residual tracheal diverticulum (34%), bronchiectasis (31%), tracheal vascular compression (21%), tracheomalacia (17%) and esophageal diverticulum (14%). Fifty three patients have undergone to airways endoscopy detecting tracheomalacia (66%), residual tracheal diverticulum (26%), recurrent tracheoesophageal fistula (19%) and vocal cord paralysis (11%). Conclusions: Our study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work up must be considered.

AB - Background: Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The aim of this study is to describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient's needs and harmonize the care. Methods: A retrospective data collection was performed on 105 children with EA and TEF followed at Department of Pediatric Medicine of Bambino Gesù Children's Hospital (Rome, Italy) between 2010 and 2015. Results: 69/105 (66%) children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years and only 63/69 (91%) performed specialist assessment at Respiratory Unit. Recurrent pneumonia (33%) and wheezing (31%) were the most reported symptoms. The first respiratory evaluation was performed after surgically correction of gastroesophageal reflux (GER) at mean age of 3.9 ± 4.2 years. Twenty nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41%), residual tracheal diverticulum (34%), bronchiectasis (31%), tracheal vascular compression (21%), tracheomalacia (17%) and esophageal diverticulum (14%). Fifty three patients have undergone to airways endoscopy detecting tracheomalacia (66%), residual tracheal diverticulum (26%), recurrent tracheoesophageal fistula (19%) and vocal cord paralysis (11%). Conclusions: Our study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work up must be considered.

KW - Congenital malformations

KW - Esophageal atresia

KW - Flexible bronchoscopy

KW - Respiratory symptoms

KW - Tracheoesophageal fistula

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U2 - 10.1186/s13052-017-0396-2

DO - 10.1186/s13052-017-0396-2

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VL - 43

JO - Italian Journal of Pediatrics

JF - Italian Journal of Pediatrics

SN - 1720-8424

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