Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia

Abstract

Summary Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.

How to Care for Patients with EA-TEF: The Known and the Unknown

“…Symptoms include feeding intolerance, barking cough, expiratory stridor, unresponsiveness to medical treatment, delayed recovery from respiratory infections, and occasionally apneic or cyanotic spells. [118]Laryngeal cleft: symptoms include recurrent wheezing, dysphagia, aspiration, or pneumoniaVocal cord abnormalities:[119] symptoms include aphonia or dysphonia, weak/hoarse cry, stridor, dysphagia, coughing with feedsGI tract problems: GERD, esophageal dysmotility, esophageal strictures GERD: As discussed earlier, EA patients are at a higher risk of GERD due intrinsic anatomic abnormalities, post surgical anatomy alteration, and altered motility from disturbed intrinsic innervation. Reflux reaching the proximal esophagus and airway can lead to respiratory symptoms.…”

“…Symptoms include feeding intolerance, barking cough, expiratory stridor, unresponsiveness to medical treatment, delayed recovery from respiratory infections, and occasionally apneic or cyanotic spells. [118]Laryngeal cleft: symptoms include recurrent wheezing, dysphagia, aspiration, or pneumoniaVocal cord abnormalities:[119] symptoms include aphonia or dysphonia, weak/hoarse cry, stridor, dysphagia, coughing with feeds…”

“…Symptoms include feeding intolerance, barking cough, expiratory stridor, unresponsiveness to medical treatment, delayed recovery from respiratory infections, and occasionally apneic or cyanotic spells. [118]…”

That antibiotic prophylaxis should be used in children with repaired oesophageal atresia and or trachea-oesophageal fistula – The case in favour

“…Obviously, the spectrum of severity in airway malacia in rEA is considerable, and may vary from life threatening to mild, but in addition to a reduced clearance of secretions, patients with rEA suffer frequently from variable (micro) aspirations [20].…”

“…Respiratory symptoms in patients with repaired EA (rEA) are very common [2]. In addition, significant other respiratory morbidity has been observed in children with rEA, besides tracheomalacia [3].…”