scholarly journals Efficacy of a standardized tube weaning program in pediatric patients with feeding difficulties after successful repair of their esophageal atresia/tracheoesophageal fistula

2020 ◽  
Vol 179 (11) ◽  
pp. 1729-1737
Author(s):  
Sabine Marinschek ◽  
Karoline Pahsini ◽  
Victor Aguiriano-Moser ◽  
Marion Russell ◽  
Barbara Plecko ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Anastomosis ◽  
Oral Feeding ◽  
Feeding Problems ◽  
Feeding Difficulties ◽  
Long Gap ◽  
Tube Weaning ◽  
Tube Dependency ◽  
Graz Model

Abstract Children born with esophageal atresia (EA) might suffer from significant oral feeding problems which could evolve into tube dependency. The primary aim of the study was to define the outcome of tube weaning in children after successful EA repair and to compare outcomes in children with short gap/TEF (tracheoesophageal fistula) and long-gap EA. Data of 64 children (28 with short-gap EA/TEF with primary anastomosis and 36 with long-gap EA with delayed surgical repair) who participated in a standardized tube weaning program based on the “Graz model of tube weaning” (in/outpatients in an intensive 3-week program, online coaching (Netcoaching) only, or a combined 2-week intensive onsite followed by online treatment “Eating School”) from 2009 to 2019 was evaluated. Sixty-one patients completed the program by transitioning to exclusive oral intake (95.3%). Three children (4.7%) were left partially weaned at the time of discharge. No significant differences could be found between short gap/TEF and long-gap EA group regarding outcomes. Conclusions: The study’s findings support the efficacy of tube weaning based on the published “Graz model of tube weaning” for children born with EA/TEF and indicate the necessity of specialized tube weaning programs for these patients. What is Known:• Children with esophageal atresia/tracheoesophageal fistula often suffer from feeding problems and tube dependency.• Different tube weaning programs and outcomes have been published, but not specifically for children with EA. What is New:• Evaluation of a large sample of children referred for tube weaning after EA repair.• Most children with EA can be weaned off their feeding tubes successfully after attending a specialized tube weaning program.

Chewing Function in Children with Repaired Esophageal Atresia–Tracheoesophageal Fistula

2017 ◽  
Vol 28 (06) ◽  
pp. 534-538 ◽  
Author(s):  
Selen Serel Arslan ◽  
Numan Demir ◽  
Aynur Karaduman ◽  
Feridun Tanyel ◽  
Tutku Soyer
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Repair ◽  
Oral Feeding ◽  
Feeding Problems ◽  
Food Texture ◽  
Significant Difference ◽  
Level 3 ◽  
Level I ◽  
Chewing Disorder

Introduction Feeding problems are common in children with esophageal atresia and tracheoesophageal fistula (EA–TEF); however, chewing disorders, which may cause inability to intake solid food, have not been evaluated. Therefore, we aimed to evaluate the chewing function in children with repaired EA–TEF. Materials and Methods Age, sex, the type of atresia, the type of repair, and the time to start oral feeding were recorded. The level of the chewing performance was scored according to the Karaduman Chewing Performance Scale (KCPS). The International Dysphagia Diet Standardization Initiative (IDDSI) was used to determine the tolerated food texture in children. Results A group of 30 patients were included, of which 53.3% was male. The percentages of the isolated-EA and that of the EA–distal TEF were 40% and 60%, respectively. The median value for the time to start oral feeding was 4.5 weeks (min = 1, max = 72). Eleven (36.7%) children had chewing disorder. The KCPS scores showed level I in six cases, level III in four cases, and level IV in one case. Five children with chewing disorder had IDDSI level 3 and six had level 7, along with the sensation of stuck food. We found no significant difference between the KCPS scores according to the repair type (p = 0.07). The median values of the KCPS scores of children with primary repair, delayed repair, and colon interposition were 0 (min = 0, max = 4), 0.5 (min = 0, max = 3), 2 (min = 0, max = 3), respectively. A significant positive correlation was found between the time to start oral feeding and the KCPS scores (r = 0.63, p = 0.001). Conclusion Chewing disorders can be observed in children with EA–TEF, and the type of repair and the delay in oral feeding may be related to chewing disorder. Therapeutic maneuvers are needed to improve the chewing function in children with EA–TEF.

DOZ047.12: A comparative analysis of concerns of caregivers with repaired esophageal Atresia-Tracheoesophageal fistula

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S S Arslan ◽  
Ö B Türer ◽  
N Demir ◽  
A Karaduman ◽  
F C Tanyel ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Repair Time ◽  
Oral Feeding ◽  
Daily Activities ◽  
Early Repair ◽  
Feeding Difficulties ◽  
Delayed Repair ◽  
Swallowing Difficulties ◽  
The Mean

Abstract Aim Children with esophageal atresia and tracheoesophageal fistula (EA-TEF) may experience feeding and swallowing difficulties, which result in stressful interactions between children and caregivers, and potentially impact the concerns of caregivers. The aim of this study was to assess concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties and compare the concerns according to type of atresia, repair time and time to start oral feeding. Methods Caregivers accompanying 24 children with EA-TEF were included. Age, sex, type of atresia, repair time, and time to start oral feeding of children were noted. Parents completed the Feeding/Swallowing Impact Survey (FS-IS) to assess the concerns of caregivers related to feeding–swallowing difficulties. It has three subscales, including daily activities, worry, and feeding difficulties. Average scores range between 1 and 5, of which increasing scores reflect more caregiver concern. Results The mean age was 3.41 ± 2.71 years, of which 66.7% were male. 56.3% of cases were isolated EA, and 43.8% were EA–distal TEF. 60.9% of cases received early repair (<1 month of age), and 39.1% had delayed repair (between 1 and 12 months). The median time to start oral feeding was 4 weeks (min = 2, max = 128). The mean scores of daily activities, worry, feeding difficulties, and the total score were 2.40 ± 1.01, 2.79 ± 1.06, 2.14 ± 0.95, and 2.49 ± 0.88, respectively. Caregivers of children with isolated EA reported more problems with ‘daily activities’, ‘feeding difficulties’, and ‘total score’ than EA–distal TEF (P < 0.05). Caregivers of children who received delayed repair reported more problems with the ‘daily activities’ subscale and ‘total score’ than children with early repair (P < 0.05). Moderate to strong correlations were found between the ‘daily activities’ and ‘feeding difficulties’ subscales of FS-IS and time to start oral feeding (P < 0.05, r = 0.56–0.69). Conclusions This study suggests that concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties are associated with the surgical outcome of EA. Caregivers of children with isolated-EA and/or delayed repair and/or delay in oral intake may have higher concerns related to feeding–swallowing difficulties.

scholarly journals Development of Suck and Swallow Mechanisms in Infants

2015 ◽  
Vol 66 (Suppl. 5) ◽  
pp. 7-14 ◽  
Author(s):  
Chantal Lau
Keyword(s):  
Health Care Professionals ◽  
Oral Feeding ◽  
Assessment Tools ◽  
Therapeutic Interventions ◽  
Feeding Problems ◽  
Feeding Difficulties ◽  
Functional Maturation ◽  
Nutritive Sucking ◽  
Integrative Level ◽  
Definition Of

Preterm infants' hospital discharge is often delayed due to their inability to feed by mouth safely and competently. No evidence-based supported guidelines are currently available for health-care professionals caring for these infants. Available interventions advocating benefits are not readily acknowledged for lack of rigorous documentation inasmuch as any improvements may ensue from infants' normal maturation. Through research, a growing understanding of the development of nutritive sucking skills has emerged, shedding light on how and why infants may encounter oral feeding difficulties due to the immaturity of specific physiologic functions. Unfortunately, this knowledge has yet to be translated to the clinical practice to improve the diagnoses of oral feeding problems through the development of relevant assessment tools and to enhance infants' oral feeding skills through the development of efficacious preventive and therapeutic interventions. This review focuses on the maturation of the various physiologic functions implicated in the transport of a bolus from the oral cavity to the stomach. Although infants' readiness for oral feeding is deemed attained when suck, swallow, and respiration are coordinated, we do not have a clear definition of what coordination implies. We have learned that each of these functions encompasses a number of elements that mature at different times and rates. Consequently, it would appear that the proper functioning of sucking, the swallow processing, and respiration need to occur at two levels: first, the elements within each function must reach an appropriate functional maturation that can work in synchrony with each other to generate an appropriate suck, swallow process, and respiration; and second, the elements of all these distinct functions, in turn, must be able to do the same at an integrative level to ensure the safe and efficient transport of a bolus from the mouth to the stomach.

scholarly journals Isolated Vaginal Agenesis Associated with Multiple Gastrointestinal Anomalies: A Case Report

2016 ◽  
Vol 5 (3) ◽  
pp. 32 ◽  
Author(s):  
Rossella Angotti ◽  
Francesco Molinaro ◽  
Anna Lavinia Bulotta ◽  
Francesco Ferrara ◽  
Marina Sica ◽  
...  
Keyword(s):  
Case Report ◽  
Esophageal Atresia ◽  
Anorectal Malformation ◽  
Tracheoesophageal Fistula ◽  
Associated Anomalies ◽  
Vaginal Agenesis ◽  
Long Gap ◽  
Unusual Association ◽  
Long Gap Esophageal Atresia

More than 50% of infants with esophageal atresia have associated anomalies. We present a case report of a 46XX neonate with long-gap esophageal atresia and tracheoesophageal fistula (EA/TEF), anorectal malformation, bowel duplication and vaginal agenesis. This is an unusual association of abnormalities which had not yet described in literature.

Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
Kaiyun Hua ◽  
Shen Yang ◽  
Yanan Zhang ◽  
Yong Zhao ◽  
Yichao Gu ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Oral Feeding ◽  
Uneventful Recovery ◽  
Severe Malnutrition ◽  
Z Score

Summary We aimed to investigate the safety, feasibility, and outcomes of thoracoscopic surgery for recurrent tracheoesophageal fistula (rTEF) after esophageal atresia repair. The medical records and follow-up data of 31 patients who underwent thoracoscopic surgery for rTEF at a single institution were collected and reviewed. In total, 31 patients were enrolled with a median age of 7 months (range: 3–30 months) and a median weight of 6,000 g (range: 4,000–12,000 g) before reoperation. The median operation time for the entire series was 2.9 hours (range: 1.5–7.5 hours), and the median total hospitalization duration after surgery was 19 days (range: 11–104 days). One patient died of anastomotic leakage, a second rTEF, severe malnutrition, and thoracic infection; the mortality rate was 3.23% (1/31). Nine patients (9/31, 29.03%) had an uneventful recovery, and the incidences of postoperative anastomotic leakage, anastomotic stricture, and second rTEF were 25.81%, 61.29%, and 9.68%, respectively. After a median follow-up of 12 months (range: 3–24 months), 26 survivors resumed full oral feeding, 2 were tube fed, 2 required a combination of methods, and 4 patients experienced severe respiratory complications. In total, 9 patients had pathological gastroesophageal reflux, and 2 patients eventually underwent Nissen fundoplication. Of the 30 survivors with growth chart data, the median weight for age Z-score, height for age Z-score, and weight for height Z-score were − 0.46 (range: −5.1 to 2.8), 0.75 (range: −2.7 to 4.7), and − 1.14 (range: −6.8 to 3.0), respectively. Thoracoscopic surgical repair for rTEF is safe, feasible, and effective with acceptable mortality and morbidity.

Aortic arch anomalies associated with long gap esophageal atresia and tracheoesophageal fistula

1997 ◽  
Vol 32 (11) ◽  
pp. 1587-1591 ◽  
Author(s):  
T.G Canty ◽  
E.M Boyle ◽  
B Linden ◽  
P.J Healey ◽  
D Tapper ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Aortic Arch Anomalies ◽  
Long Gap ◽  
Long Gap Esophageal Atresia
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