Long-Term Outcomes in Esophageal Atresia: Nutritional Management and Growth-Development

Yıl 2024, Cilt: 13 Sayı: 4, 2027 - 2034, 25.12.2024

Dilara Berşan Konyalıgil , Nevra Koç

https://doi.org/10.37989/gumussagbil.1505191

Öz

The aim of this review is to summarize the nutritional management, malnutrition and growth and development in esophageal atresia based on various studies and available literature. Esophageal atresia is defined as a congenital malformation characterized by the absence of continuity of the esophagus, with or without tracheoesophageal fistula. Esophageal atresia is treated surgically to correct the esophageal interruption and to ligate and divide the tracheoesophageal fistula, if present. Survival in those born with esophageal atresia with severe associated anomalies has now reached ~90%, and is even higher in those born with esophageal atresia alone. Despite these successes, long-term gastrointestinal and respiratory complications and comorbidities are common in patients born with esophageal atresia and lead to a reduced quality of life. Feeding difficulties are common in patients after surgical intervention. The long-term negative effects of esophageal atresia can lead to poor nutritional status and growth retardation in children. Ongoing aversive events such as vomiting, coughing and choking may delay feeding skills and reduce children's interest in feeding, and these feeding problems may develop into ongoing feeding difficulties with behavioral factors over time. Malnutrition is common in malnourished children with esophageal atresia. Management of feeding problems is the most important factor that can prevent inadequate growth of sick children.

Anahtar Kelimeler

Esophageal atresia, Growth, Malnutrition, Nutrition

Özofagus Atrezisinde Uzun Vadeli Sonuçlar: Beslenme Yönetimi ve Büyüme-Gelişme

Öz

Bu derlemenin amacı, özofagus atrezisinde beslenme yönetimi, malnütrisyon ve büyüme ve gelişme durumunu, çeşitli çalışmalar ve mevcut literatür temelinde özetlemektir. Özofagus atrezisi, trakeoözofageal fistüllü veya fistülsüz, özofagusun devamlılığının olmaması ile karakterize konjenital bir malformasyon olarak tanımlanmaktadır. Özofagus atrezisi, özofagus kesintisini düzeltmek ve varsa trakeoözofageal fistülü bağlamak ve bölmek için cerrahi olarak tedavi edilmektedir. Ciddi ilişkili anomalilerle birlikte günümüzde özofagus atrezisi ile doğanlarda sağkalım ~%90'lara ulaşmıştır ve tek başına özofagus atrezisi ile doğanlarda bu oran daha da yüksektir. Bu başarılara rağmen, özofagus atrezisi ile doğan hastalarda uzun vadeli gastrointestinal ve solunum komplikasyonları, komorbiditeler yaygındır ve yaşam kalitesinin düşmesine neden olur. Cerrahi müdahale sonrası hastalarda beslenme güçlüğü sık gözlenmektedir. Özofagus atrezisinin uzun dönemli negatif etkileri, çocuklarda beslenme durumunun bozulmasına ve büyüme geriliğine neden olabilir. Kusma, öksürme, boğulma gibi devam eden bir takım caydırıcı olaylar, beslenme becerilerini geciktirebilir ve çocukların beslenmeye olan ilgilerini azaltabilir ve bu beslenme sorunları zamanla davranışsal faktörlerle devam eden beslenme güçlüklerine dönüşebilir. Yetersiz beslenen özofagus atrezili çocuklarda malnütrisyon sık gözlenmektedir. Beslenme sorunlarının yönetimi, hasta çocukların yetersiz büyümesine engel olabilecek en önemli faktördür.

Anahtar Kelimeler

Beslenme, Büyüme, Malnütrisyon, Özofagus atrezisi

Kaynakça

• 1. McGowan, N.A. and Grosel, J. (2022). “An Overview of Esophageal Atresia and Tracheoesophageal Fistula.” Journal of the American Academy of PAs, 35 (6), 34-37. https://doi.org/10.1097/01.JAA.0000830180.79745.b9.
• 2. Cassina, M, Ruol, M, Pertile, R, Midrio, P, Piffer S, Vicenzi, V, Saugo, M, Stocco, C.F, Gamba, P. and Clementi, M. (2016). “Prevalence, Characteristics, and Survival of Children with Esophageal Atresia: A 32-Year Population-Based Study İncluding 1,417,724 Consecutive Newborns.” Birth Defects Research. Part A, Clinical And Molecular Teratology, 106 (7), 542-548. https://doi.org/10.1002/bdra.23493.
• 3. Örnö Ax, S, Dellenmark-Blom, M, Abrahamsson, K, Jönsson, L. and Gatzinsky, V. (2023). “The Association of Feeding Difficulties and Generic Health-Related Quality of Life Among Children Born with Esophageal Atresia.” Orphanet Journal of Rare Diseases, 18 (1), 237. https://doi.org/10.1186/s13023-023-02836-w.
• 4. Pelizzo, G, Destro, F, Selvaggio, G.G.O, Maestri, L, Roveri, M, Bosetti, A, Borsani, B, Pendezza, E, Meroni, M, Pansini, A, La Pergola, E, Riccipetitoni, G, De Silvestri, A, Cena, H. and Calcaterra, V. (2020). “Esophageal Atresia: Nutritional Status and Energy Metabolism to Maximize Growth Outcome.” Children (Basel), 7 (11), 228. https://doi.org/10.3390/children7110228.
• 5. Guptha, S, Shumate, C. and Scheuerle, AE. (2019). “Likelihood of Meeting Defined VATER/VACTERL Phenotype in İnfants with Esophageal Atresia with or without Tracheoesophageal Fistula.” American Journal of Medical Genetics Part A, 179 (11), 2202–2206.
• 6. Krishnan, U, Mousa, H, Dall'Oglio, L, Homaira, N, Rosen, R, Faure, C. and Gottrand, F. (2016). “ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula.” The Journal of Pediatric Gastroenterology and Nutrition, 63 (5), 550-570. https://doi.org/10.1097/MPG.0000000000001401.
• 7. Ramsay, M. and Birnbaum, R. (2013). Feeding Difficulties in Children with Esophageal Atresia: Treatment by A Multidisciplinary Team. Diseases of the Esophagus, 26 (4), 410-412 https://doi.org/10.1111/dote.12062.
• 8. Mutlu, A.U, Kızılkaya, O. and İnan, M. (2019). A Newborn With Esophageal Atresia, Tracheoesophageal Fistula and Feeding Problems. Turkish Medical Student Journal, 6 (2), 60-63. https://doi.org/10.4274/tmsj.galenos.2019.06.02.04
• 9. Bradshaw, C.J, Thakkar, H, Knutzen, L, Marsh, R, Pacilli, M, Impey, L. and Lakhoo, K. (2016). “Accuracy of Prenatal Detection of Tracheoesophageal Fistula and Oesophageal Atresia.” Journal Of Pediatric Surgery, 51 (8). https://doi.org/1268-1272. 10.1016/j.jpedsurg.2016.02.001.
• 10. Pardy, C, D’Antonio, F, Khalil, A. and Giuliani, S. (2019). “Prenatal Detection of Esophageal Atresia: A Systematic Review and Meta-Analysis.” Acta Obstetricia et Gynecologica Scandinavica, 98 (6), 689-699. https://doi.org/10.1111/aogs.13536.
• 11. Garabedian, C, Vaast, P, Bigot, J, Sfeir, R, Michaud, L, Gottrand, F, Verpillat, P, Coulon, C, Subtil, D. and Houfflin Debarge, V. (2014). “Atrésie De L'œsophage: Prévalence, Diagnostic Anténatal Et Pronostic [Esophageal Atresia: Prevalence, Prenatal Diagnosis And Prognosis].” Journal of Gynecology Obstetrics and Human Reproduction (Paris), 43 (6), 424-430. French. https://doi.org/10.1016/j.jgyn.2013.11.014.
• 12. van Lennep, M, Singendonk, M.M.J, Dall'Oglio, L, Gottrand, F, Krishnan, U, Terheggen-Lagro, S.W.J, Omari, T.I, Benninga, M.A. and van Wijk, M.P. (2019). “Oesophageal Atresia.” Nature Reviews Disease Primers, 5 (1), 26. https://doi.org/10.1038/s41572-019-0077-0
• 13. Ardenghi, C, Vestri, E, Costanzo, S, Lanfranchi, G, Vertemati, M, Destro, F, Pierucci, U.M, Calcaterra, V. and Pelizzo, G. (2022). “Congenital Esophageal Atresia Long-Term Follow-Up—The Pediatric Surgeon’s Duty to Focus on Quality of Life.” Children, 9 (3),331. https://doi.org/10.3390/children9030331.
• 14. Gross, R.E. (1953). ‘’The Surgery of İnfancy and Childhood’’. 1st ed. Philadelphia: WB Saunders.
• 15. Macchini, F, Parente, G, Morandi, A, Farris, G, Gentilino, V. and Leva, E. (2018). Classification of Esophageal Strictures Following Esophageal Atresia Repair. European Journal of Pediatric Surgery, 28 (03), 243-249. https://doi.org/10.1055/s-0037-1598656
• 16. Goyal, A. (2006). Oesophageal Atresia and Tracheo-Oesophageal Fistula. Archives of Disease in Childhood - Fetal and Neonatal Edition, 91 (5), F381–F384. https://doi.org/10.1136/adc.2005.086157.
• 17. Quan, L. and Smith, D.W. (1973). The VATER Association. Vertebral Defects, Anal Atresia, T-E Fistula with Esophageal Atresia, Radial and Renal Dysplasia: A Spectrum of Associated Defects. The Journal of pediatrics, 82 (1), 104-107. https://doi.org/10.1016/S0022-3476(73)80024-1.
• 18. Bjørsum-Meyer, T, Herlin, M, Qvist, N. and Petersen, M.B. (2016). “Vertebral Defect, Anal Atresia, Cardiac Defect, Tracheoesophageal Fistula/Esophageal Atresia, Renal Defect, and Limb Defect Association with Mayer-Rokitansky-Küster-Hauser Syndrome in Co-Occurrence: Two Case Reports and A Review of the Literature.” Journal of Medical Case Reports, 10 (1), 374. https://doi.org/10.1186/s13256-016-1127-9.
• 19. Diaz, J, Chavers, B, Chinnakotla, S. and Verghese, P. (2019). “Outcomes Of Kidney Transplants in Pediatric Patients with the Vertebral Defects, Anal Atresia, Cardiac Defects, Tracheoesophageal Fistula, Renal Anomalies, Limb Abnormalities Association.” Pediatric Transplantation, 23 (2), 13341. https://doi.org/10.1111/petr.13341.
• 20. Ramos, J.A, Shettar, S.S. and James, C.F. (2018). Neuraxial Analgesia in A Parturient with the VACTERL Association Undergoing Labor and Vaginal Delivery. Brazilian Journal of Anesthesiology, 68 (2), 205–208. https://doi.org/10.1016/j.bjan.2016.05.002.
• 21. Traini, I, Menzies, J, Hughes, J, Leach, S.T. and Krishnan, U. (2020). Oesophageal Atresia: The Growth Gap. World Journal of Gastroenterology, 26 (12), 1262. https://doi.org/10.3748/wjg.v26.i12.1262.
• 22. Lal, D.R, Gadepalli, S.K, Downard, C.D, Ostlie, D.J, Minneci, P.C, Swedler, R.M, Chelius, T, Cassidy, L, Rapp, C.T, Deans, K.J, Fallat, M.E, Finnell, S.M.E, Helmrath, M.A, Hirschl, R.B, Kabre, R.S, Leys, C.M, Mak, G, Raque, J, Rescorla, F.J, Saito, J.M, St Peter, SD, von Allmen, D, Warner, B.W. and Sato, T.T. Midwest Pediatric Surgery Consortium (2017). Perioperative Management and Outcomes of Esophageal Atresia and Tracheoesophageal Fistula. Journal of Pediatric Surgery, 52 (8), 1245-1251. https://doi.org/10.1016/j.jpedsurg.2016.11.046.
• 23. Donoso, F, Kassa, A.M, Gustafson, E, Meurling, S. and Lilja, H.E. (2016). Outcome and Management in İnfants with Esophageal Atresia–A Single Centre Observational Study. Journal of Pediatric Surgery, 51 (9), 1421-1425. https://doi.org/ 10.1016/j.jpedsurg.2016.03.010.
• 24. Wu, Y, Kuang, H, Lv, T. and Wu, C. (2017). Comparison of Clinical Outcomes Between Open and Thoracoscopic Repair for Esophageal Atresia with Tracheoesophageal Fistula: A Systematic Review and Meta-Analysis. Pediatric Surgery İnternational, 33, 1147-1157. https://doi.org/10.1007/s00383-017-4153-9.
• 25. Morini, F, Conforti, A. and Bagolan, P. (2018). Perioperative Complications of Esophageal Atresia. European Journal of Pediatric Surgery, 28 (02), 133-140. https://doi.org/10.1055/s-0038-1636941.
• 26. Banjar, H. (2006). Tracheomalacia Following Repair of Esophageal Atresia and Tracheoesophageal Fistula. Current Pediatric Research, 10, 13-18.
• 27. Tiryaki, T, Atayurt, H, Livanelioğlu, Z, Şenel, E. ve Akbıyık, F. (2010). Beslenme Jejunostomisi; Özofagus Atrezili Olguların Tedavisinde Hayat Kurtarıcı Bir Uygulama. Türkiye Çocuk Hastalıkları Dergisi, 4 (3), 165-170.
• 28. Keefe, G, Culbreath, K, Edwards, E.M, Morrow, K.A, Soll, R.F, Modi, B.P, Horbar, J.D. and Jaksic, T. (2022). Current Outcomes of İnfants with Esophageal Atresia and Tracheoesophageal Fistula: A Multicenter Analysis. Journal of Pediatric Surgery, 57 (6), 970-974. https://doi.org/10.1016/j.jpedsurg.2022.01.060.
• 29. Puntis, J.W, Ritson, D.G, Holden, C.E. and Buick, R.G. (1990). Growth And Feeding Problems After Repair Of Oesophageal Atresia. Archives of Disease in Childhood, 65 (1):84–8. https://doi.org/10.1136/adc.65.1.84.
• 30. Menzies, J, Hughes, J, Leach S, Belessis, Y. and Krishnan, U. (2017). Prevalence of Malnutrition qnd Feeding Difficulties in Children with Esophageal Atresia. Journal of Pediatric Gastroenterology and Nutrition, 64 (4):e100–5. https://doi.org/10.1097/MPG.0000000000001436.
• 31. Chetcuti, P. and Phelan, P.D. (1993). Gastrointestinal Morbidity and Growth After Repair of Oesophageal Atresia and Tracheo-Oesophageal Fistula. Archives of Disease in Childhood, 68 (2):163–166. https://doi.org/10.1136/adc.68.2.167.
• 32. Schier, F, Korn, S. and Miche,l E. (2001). Experiences of a Parent Support Group with the Long-Term Consequences of Esophageal Atresia. Journal of Pediatric Surgery, 36 (4):605–610. https://doi.org/10.1053/jpsu.2001.22299.
• 33. Conforti, A, Valfré, L, Falbo, M, Bagolan, P. and Cerchiari, A. (2015). Feeding and Swallowing Disorders in Esophageal Atresia Patients: A Review of a Critical Issue. European Journal of Pediatric Surgery, 25 (04), 318–325. https://doi.org/10.1055/s-0035-1559819
• 34. Mahoney, L. and Rosen, R. (2016). Feeding Difficulties in Children with Esophageal Atresia. Paediatric Respiratory Reviews, 19:21–27. https://doi.org/10.1016/j.prrv.2015.06.002.
• 35. Askarpour, S, Peyvasteh, M, Dashtyan, M, Javaherizadeh, H, Ahmadi, M. and Ali-Samir, M. (2020). Incidence of Malnutrition, Esophageal Stenosis and Respiratory Complications among Children with Repaired Esophageal Atresia. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 33 (3):e1537. https://doi.org/10.1590/0102-672020200003e1537.
• 36. Guan, X.S, Yu, J.K, Zhong, W, Li, L, Wang, Y, He, Q.M. and Li, RQ. (2013). Treatment Strategy and Prognosis Analysis in Children with Type I Esophageal Atresia. Zhonghua Wei Chang Wai Ke Za Zhi. Chinese Journal of Gastrointestinal Surgery, 16 (9), 860-863. https://doi.org/10.3760/cma.j.issn.1671-0274.2013.09.015.
• 37. IJsselstijn, H, Gischler, S.J, Toussaint, L, Spoel, M, van der Cammen-van, M.H. and Tibboel, D. (2016). Growth and Development after Oesophageal Atresia Surgery: Need for Long-Term Multidisciplinary Follow-Up. Paediatric Respiratory Reviews, 19, 34-38. https://doi.org/10.1016/j.prrv.2015.07.003.
• 38. Little, D.C, Rescorla, F.J, Grosfeld, J.L, West, K.W, Scherer, L.R. and Engum, S.A. (2003). Long-Term Analysis of Children with Esophageal Atresia and Tracheoesophageal Fistula. Journal of Pediatric Surgery, 38 (6), 852-856. https://doi.org/10.1016/S0022-3468(03)00110-6.
• 39. Lacher, M, Froehlich, S, Von Schweinitz, D. and Dietz, H.G. (2010). Early and Long Term Outcome in Children with Esophageal Atresia Treated over the Last 22 Years. Klinische Pädiatrie, 222 (05), 296-301. https://doi.org/10.1055/s-0030-1249610.
• 40. Jönsson, L, Friberg, L.G, Gatzinsky, V, Kötz, K, Sillén, U. and Abrahamsson, K. (2016). Treatment and Follow-Up of Patients with Long-Gap Esophageal Atresia: 15 Years of Experience from the Western Region of Sweden. European Journal of Pediatric Surgery, 26 (02), 150-159. https://doi.org/10.1055/s-0034-1396415.
• 41. Legrand, C, Michaud, L, Salleron, J, Neut, D, Sfeir, R, Thumerelle, C, Bonnevalle, M, Turck D. and Gottrand, F. (2012). Long-Term Outcome of Children with Oesophageal Atresia Type III. Archives of Disease in Childhood, 97 (9), 808-811. https://doi.org/10.1136/archdischild-2012-301730.
• 42. Spitz, L. (1993). Esophageal Atresia and Tracheoesophageal Fistula in Children. Current Opinion in Pediatrics, 5 (3), 347-352. https://doi.org/10.1097/00008480-199306000-00017.
• 43. Chetcuti, P. and Phelan, P.D. (1993). Respiratory Morbidity After Repair of Oesophageal Atresia and Tracheo-Oesophageal Fistula. Archives of Disease in Childhood, 68 (2), 167-170. https://doi.org/10.1136/adc.68.2.167.
• 44. Nambirajan, L, Rintala, R.J, Losty, P.D, Carty, H. and Lloyd, D.A. (1998). The Value of Early Postoperative Oesophagography Following Repair of Oesophageal Atresia. Pediatric Surgery İnternational, 13, 76-78. https://doi.org/10.1007/s003830050252.
• 45. Engum, S.A, Grosfeld, J.L, West, K.W, Rescorla, F.J. and Scherer, L.T. (1995). Analysis of Morbidity and Mortality in 227 Cases of Esophageal Atresia and/or Tracheoesophageal Fistula over Two Decades. Archives of Surgery, 130 (5), 502-508. https://doi.org/10.1001/archsurg.1995.01430050052008
• 46. Somppi, E, Tammela, O, Ruuska, T, Rahnasto, J, Laitinen, J, Turjanmaa, V. and Järnberg, J. (1998). Outcome of Patients Operated on for Esophageal Atresia: 30 Years' Experience. Journal of Pediatric Surgery, 33 (9), 1341-1346. https://doi.org/10.1016/S0022-3468(98)90003-3.
• 47. LeSouëf, P.N, Myers, N.A. and Landau, L.I. (1987). Etiologic Factors in Long-Term Respiratory Functionabnormalities Following Esophageal Atresia Repair. Journal of Pediatric Surgery, 22 (10), 918-922. https://doi.org/10.1016/S0022-3468(87)80589-4.