Psychological impact of esophageal atresia: review of the research and clinical evidence

Abstract

Esophageal atresia (EA) occurs in one out of 2500 to 4500 live births. As the vast majority of infants are now surviving neonatal corrective surgery, the focus has shifted from mortality to morbidity associated with EA. However, little is known about its psychological morbidity. This paper synthesizes research and clinical evidence to highlight the psychological sequelae of EA, including its impact on parents' psychological functioning and its effects on child development from infancy to adulthood. Whether it is discovered at birth or prenatally, EA is a psychologically traumatic event, and parents are at risk for developing traumatic stress reactions following diagnosis. Neonatal surgery and intensive care, risk of complications, associated anomalies, and genetic etiologies multiply risk for parents' acute and post-traumatic stress disorders (PTSD). Parental PTSD has a negative impact on infant and child development through its effects on parenting skills and parent-child interactions. EA children are also at risk for PTSD because of invasive and stressful procedures they undergo during the neonatal period. Consequences of EA can have an important long-term impact on children's psychological and social development. The scant studies pertaining to cognitive functioning suggest that EA does not affect mental development during infancy, but may be associated with deficits as children reach school age. Long-term sequelae are unclear because psychological functioning in adults has not yet been adequately examined. Research and clinical evidence of psychological morbidity associated with EA has implications for clinical practice. Psychological support for parents must begin during the neonatal period and should continue as an integral component of long-term follow up for both children and parents. Support is best provided within the context of a multidisciplinary treatment team that follows patients from birth through childhood and adolescence. Psychological follow up should continue into adulthood, as patients grow up and transition from pediatric to adult health-care settings.

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

“…6 As reported EA survival rates have increased to more than 90% nowadays, 7,8 leading to a shift of attention towards possible long-term morbidities. 9 Previous research on developmental outcome after EA/TEF repair showed normal to impaired motor-and mental development. The impairment was associated with the total anesthesia time.…”

“…Thoracoscopic management is preferred in some hospitals because it provides better visualization of the surgical field, and is associated with less surgical damage and better long‐term outcome with expected lower risk of scoliosis . As reported EA survival rates have increased to more than 90% nowadays, leading to a shift of attention towards possible long‐term morbidities . Previous research on developmental outcome after EA/TEF repair showed normal to impaired motor‐ and mental development.…”

Management and outcome of neonates with a prenatal diagnosis of esophageal atresia type A: A population‐based study

“…Clearly, antenatal detection helps future parents to prepare for the birth of an affected infant who will require surgery and intensive care. It also avoids postnatal separation, which can lead to psychological trauma during an important moment for mother‐infant bonding . In the context of an antenatal diagnosis of a fetal digestive abnormality, Aite et al showed that, indeed, there is a positive impact of a multidisciplinary approach on maternal anxiety following both the initial antenatal consultation and the birth .…”

“…It also avoids postnatal separation, which can lead to psychological trauma during an important moment for mother-infant bonding. 24 In the context of an antenatal diagnosis of a fetal digestive abnormality, Aite et al showed that, indeed, there is a positive impact of a multidisciplinary approach on maternal anxiety following both the initial antenatal consultation and the birth. 25 survival rate was similar in our sample and appears reassuring compared with older reports.…”

Thoracoabdominal and General Surgery

“…Long-term respiratory complications including bronchiectasis may result from aspiration, GERD, and chest wall abnormalities [ 104 ]. Both the parents and their neonate are at risk for psychological and traumatic stress (including post-traumatic stress disorder) [ 105 ]. These are long-term issues centered around feeding diffi culties, multiple painful procedures and surgeries, feeding, and airway issues.…”