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Pham A, Ezzeddine L, Bonnard A, Lapillonne A, Rousseau V, Montalva L, Khattat N, Guilbert J, Mokhtari M, Fouquet V, Jaby O, Decobert F, Mitanchez D, Ducou Le Pointe H, Irtan S. Usefulness of routine early œsophagogram after primary repair of œsophageal atresia: a multicenter study. Pediatr Res 2023; 94:1779-1783. [PMID: 37328687 DOI: 10.1038/s41390-023-02696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Advances in surgical and neonatal care have led to improved survival of patients with œsophageal atresia (OA) over time. Morbidity remains significant, with one-third of patients being affected by a postoperative complication. Several aspects of management are not consensual, such as the use of œsophagogram before starting oral feeding. METHODS We conducted a multicenter retrospective study, including all children with OA that underwent a primary anastomosis in the first days of life, between 2012 and 2018 in five French centers, to determine the usefulness of postoperative œsophagogram during the 10 days after early primary repair of OA to diagnose the anastomotic leak and congenital œsophageal stenosis. RESULTS Among 225 included children, 90 (40%) had a routine œsophagogram and 25 (11%) had an anastomotic leak, clinically diagnosed before the scheduled œsophagogram in 24/25 (96%) children at median postoperative day 4. Ten patients had associated congenital œsophageal stenosis diagnosed on the œsophagogram in only 30% of cases. CONCLUSION Early œsophagogram is rarely useful in the diagnosis of an anastomotic leak, which is clinically diagnosed before performing an œsophagogram in the majority of cases. The need for a postoperative œsophagogram should be evaluated on a case-by-case basis. IMPACT Early œsophagogram is not helpful in the diagnosis of an anastomotic leak in the majority of cases. An anastomotic leak is most often diagnosed clinically before performing an œsophagogram. Early postoperative œsophagogram could be helpful for the diagnosis of congenital œsophageal stenosis. However, dysphagia occurs later and early diagnosis of congenital œsophageal stenosis has no impact on the management and outcome of asymptomatic children. Indication of postoperative œsophagogram has to be evaluated on a case-by-case basis.
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Affiliation(s)
- Aurélie Pham
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Neonatal Medicine, 75012, Paris, France.
| | - Lynn Ezzeddine
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Arnaud Bonnard
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Alexandre Lapillonne
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Neonatal Intensive Care Unit, 75015, Paris, France
| | - Véronique Rousseau
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Department of Pediatric Surgery, 75015, Paris, France
| | - Louise Montalva
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Nizar Khattat
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Neonatal Intensive care unit, 75019, Paris, France
| | - Julia Guilbert
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Intensive neonatal and pediatric care unit, 75012, Paris, France
| | - Mostafa Mokhtari
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Neonatal Intensive care unit, 94250, Le Kremlin Bicêtre, France
| | - Virginie Fouquet
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Department of Pediatric Surgery, 94250, Le Kremlin Bicêtre, France
| | - Olivier Jaby
- Centre hospitalier intercommunal de Créteil, Department of Pediatric Surgery, 94300, Créteil, France
| | - Fabrice Decobert
- Centre hospitalier intercommunal de Créteil, Neonatal Intensive Care Unit, 94300, Créteil, France
| | - Delphine Mitanchez
- François Rabelais University, CHRU de Tours, Bretonneau Hospital, Neonatal Intensive Care Unit, 37000, Tours, France
| | - Hubert Ducou Le Pointe
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Sabine Irtan
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of visceral and neonatal pediatric surgery, 75012, Paris, France
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Graham ME. Supporting Breastfeeding in Complex Pediatric Otolaryngology Dyads: Clinical Pathway With Illustrative Case Series. Ann Otol Rhinol Laryngol 2023; 132:1194-1199. [PMID: 36503275 PMCID: PMC10466998 DOI: 10.1177/00034894221140771] [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] [Indexed: 08/23/2023]
Abstract
OBJECTIVES The benefits of breastfeeding are well established, yet complex infants are less frequently supported to feed direct or pumped breastmilk. This article aims to provide an algorithm to support complex infants in meeting breastfeeding goals. METHODS Two cases are presented to illustrate the breastfeeding support pathway. Each involves early identification of motivated caregivers, consultation of allied health, and assessment of swallowing safety with modification of position or route as appropriate. RESULTS Two infants presented herein successfully continued to receive breastmilk despite airway complexity-1 with oral aversion secondary to prolonged nil per os period in the setting of tracheoesophageal fistula, and 1 with a tracheostomy secondary to subglottic stenosis. CONCLUSIONS It is both possible and imperative to support complex infants in continuing to breastfeed, either directly or via the safest possible route, for the benefits to both members of the dyad.
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Affiliation(s)
- M. Elise Graham
- Children’s Hospital at London Health Sciences Centre, London, ON, Canada
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Yasuda JL, Taslitsky GN, Staffa SJ, Ngo PD, Meisner J, Mohammed S, Hamilton T, Zendejas B, Manfredi MA. Predictors of enteral tube dependence in pediatric esophageal atresia. Dis Esophagus 2023; 36:6692452. [PMID: 36065605 DOI: 10.1093/dote/doac060] [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] [Received: 05/24/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 12/11/2022]
Abstract
Children with esophageal atresia (EA) may require enteral tube feedings in infancy and a subset experience ongoing feeding difficulties and enteral tube dependence. Predictors of enteral tube dependence have never been systematically explored in this population. We hypothesized that enteral tube dependence is multifactorial in nature, with likely important contributions from anastomotic stricture. Cross-sectional clinical, feeding, and endoscopic data were extracted from a prospectively collected database of endoscopies performed in EA patients between August 2019 and August 2021 at an international referral center for EA management. Clinical factors known or hypothesized to contribute to esophageal dysphagia, oropharyngeal dysphagia, or other difficulties in meeting caloric needs were incorporated into regression models for statistical analysis. Significant predictors of enteral tube dependence were statistically identified. Three-hundred thirty children with EA were eligible for analysis. Ninety-seven were dependent on enteral tube feeds. Younger age, lower weight Z scores, long gap atresia, neurodevelopmental risk factor(s), significant cardiac disease, vocal fold movement impairment, and smaller esophageal anastomotic diameter were significantly associated with enteral tube dependence in univariate analyses; only weight Z scores, vocal fold movement impairment, and anastomotic diameter retained significance in a multivariable logistic regression model. In the current study, anastomotic stricture is the only potentially modifiable significant predictor of enteral tube dependence that is identified.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Gabriela N Taslitsky
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Thomas Hamilton
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
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Stewart A, Smith CH, Govender R, Eaton S, De Coppi P, Wray J. Parents' experiences of feeding children born with oesophageal atresia/tracheo-oesophageal fistula. J Pediatr Surg 2022; 57:792-799. [PMID: 36150934 PMCID: PMC9728016 DOI: 10.1016/j.jpedsurg.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Feeding difficulties are widely acknowledged following oesophageal atresia/tracheo-oesophageal fistula repair. However, little is understood about the nature and severity of these difficulties. This study explored feeding in children with oesophageal atresia/tracheo-oesophageal fistula from the parent perspective. METHODS In collaboration with a patient support group, data were collected using a research-specific online discussion forum. Thematic analysis was used to code the data and identify themes. RESULTS One hundred and twenty-seven parents registered for the online forum, of whom 83 (65%) provided demographic data. Seventy-four (89%) of responders were mothers, 75 (90%) were of white ethnicity, 65 (78%) were from the UK. Six key themes were identified: feeding is a traumatic experience, feeding my child is scary, feeding is isolating and filled with uncertainty, feeding outside of the home is difficult, feeding associated emotions, developing coping strategies. Parents described features of medical, nutritional, feeding skill and psychosocial dysfunction across all stages of eating/drinking development. They described how their child's feeding difficulties had an impacted their own well-being. An interactional model of feeding difficulties in OA/TOF is proposed. CONCLUSIONS Exploring parent experiences provides rich data from which to expand understanding of the complex nature of feeding difficulties in OA/TOF. Feeding should be viewed as a dyadic process, occurring within a family system. Intervention for feeding difficulties should be family-centred, addressing parental anxiety, trauma and uncertainty, as well as the child's underlying medical/surgical needs to optimise outcome. Further study of clinical correlates with parental experience is required. LEVEL OF EVIDENCE IV (non-experimental, qualitative).
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Affiliation(s)
- Alexandra Stewart
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Christina H. Smith
- Department of Language and Cognition, University College London, Chandler house, 2 Wakefield Street, London, WC1N 1PF, UK
| | - Roganie Govender
- Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK,Head and Neck Academic Centre, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK,Stem Cells and Regenerative Medicine Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Wallace V, Honkalampi K, Korhonen M. Fear, isolation and the importance of support: A qualitative study of parents' experiences of feeding a child born with esophageal atresia. J Pediatr Nurs 2022; 67:e9-e15. [PMID: 36336533 DOI: 10.1016/j.pedn.2022.10.011] [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] [Received: 05/06/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Feeding and swallowing difficulties in children are increasing due to improved survival rates of children with complex medical conditions. Despite being common complications of esophageal atresia (EA), EA related feeding difficulties have received little attention in research. Establishing positive feeding interactions and practices are important for child health and development, and for parental and child mental health. The current study aimed to investigate the parental experiences of feeding a child born with EA. METHODS An international online survey was developed and disseminated to parents of children born with EA, aged 0-12 years, in collaboration with a patient charity for EA. Reflexive Thematic Analysis was used to analyze the qualitative survey responses. RESULTS 176 participants were included in the qualitative sample from a larger international online survey study, chosen by a process of selective coding. Three themes were constructed during the analysis: 1) Anxiety, trauma and loss; 2) Isolated and unsupported; and 3) Supported. The results indicated that parents of children born with EA experienced significant anxiety related to their child's swallowing and feeding difficulties and traumatic experiences during feeding, and that these led to parents feeling a sense of loss and sadness. It was also found that support, or a lack of support, within parents' social environment might mediate parental experiences of child's feeding difficulties. CONCLUSIONS This study highlighted the importance of support for parents of children born with EA, and suggested a need for improved guidance for feeding and swallowing difficulties.
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Affiliation(s)
- Vuokko Wallace
- Department of Clinical Psychology, University of Bath, UK; Department of Psychology, University of Eastern Finland, Finland.
| | - Kirsi Honkalampi
- Department of Psychology, University of Eastern Finland, Finland
| | - Maija Korhonen
- Department of Psychology, University of Eastern Finland, Finland
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Ren Z, Lan H, Szeto IMY, Yang C, Zhang J, Li P, Li J, Wang P, Zhang Y, Zhao A. Feeding Difficulty Among Chinese Toddlers Aged 1-3 Years and Its Association With Health and Development. Front Pediatr 2021; 9:758176. [PMID: 34888269 PMCID: PMC8650057 DOI: 10.3389/fped.2021.758176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Feeding problems are biopsychosocial in nature and have a great influence on children's growth. The aim of this study was to profile the status and possible influencing factors of feeding difficulty among normal Chinese toddlers, and to investigate its association with health and development. This study is a part of the Young Investigation (YI study) conducted in 10 cities in China. Data from 924 children aged 1-3 years were analyzed. Data on socio-demographic factors, feeding behaviors, self-reported diseases, and anthropometry parameters were collected. Blood samples were drawn to determine hemoglobin levels. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCH-FS). Ages and Stages Questionnaires, Third Edition (ASQ-3) were used to assess developmental progress. Multivariable analyses were performed to explore the potential associations. The mean total score of the MCH-FS was 35.21 ± 12.90 and the highest scored item was "acting up/making a big fuss during mealtimes." Feeding difficulty occurred more often among children with picky eating behavior or whose caregivers once used the strategy of pre-mastication. Children with feeding difficulty had lower intakes of cereals, vegetables, and fruits, and were more likely to suffer from diarrhea (OR, 2.04; 95%CI: 1.32, 3.11) or constipation (OR, 2.04; 95%CI: 1.27, 3.24), but not anemia. Feeding difficulty was also negatively associated with weight, height, head circumference and mid-upper-arm circumference-related Z-scores (P all < 0.05). In addition, it was related to poorer fine motor skills, personal and social skills, and total scores of ASQ-3 (β, -9.00; 95%CI: -15.11, -2.89). Feeding difficulty assessed by MCH-FS showed a negative association with children's health and development, supporting the need for early identification.
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Affiliation(s)
- Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jingwen Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Peiyu Wang
- Department of Social Science and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
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