Highlights
- •What is currently known about this topic?
Tracheomalacia is associated with ALTEs in EA/TEF patients. Surgical procedures reduce
the short-term recurrence of ALTEs.
- 2.What new information is contained in this article?
ALTE incidence is 22.2% and they mostly occur before age 1-year. ALTEs are associated
with low BW, low GA, and esophageal strictures. The recurrence of long-term ALTEs
after esophageal dilatation, fundoplication, and airway pexy are described.
Summary
Background
Following surgical correction, many patients with esophageal atresia with or without
tracheoesophageal fistula (EA/TEF) present to the emergency department (ED) with acute
airway complications. We sought to determine the incidence and risk factors for severe
acute life-threatening events (ALTEs) in pediatric patients with repaired congenital
EA/TEF and the outcomes of operative interventions.
Methods
A retrospective cohort chart review was performed on patients with EA/TEF with surgical
repair and follow-up at a single centre from 2000 to 2018. Primary outcomes included
5-year ED visits and/or hospitalizations for ALTEs. Demographic, operative, and outcome
data were collected. Chi-square tests and univariate analyses were performed.
Results
In total, 266 EA/TEF patients met inclusion criteria. Of these, 59 (22.2%) had experienced
ALTEs. Patients with low birth weight, low gestational age, documented tracheomalacia,
and clinically significant esophageal strictures were more likely to experience ALTEs
(p < 0.05). ALTEs occurred prior to 1 year of age in 76.3% (45/59) of patients with
a median age at presentation of 8 months (range 0-51 months). Recurrence of ALTEs
after esophageal dilatation was 45.5% (10/22), mostly due to stricture recurrence.
Patients experiencing ALTEs received anti-reflux procedures (8/59, 13.6%), airway
pexy procedures (7/59, 11.9%), or both (5/59, 8.5%) within a median age of 6 months
of life. The resolution and recurrence of ALTEs after operative interventions are
described.
Conclusion
Significant respiratory morbidity is common among patients with EA/TEF. Understanding
the multifactorial etiology and operative management of ALTEs have an important role
in their resolution.
Keywords
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Article info
Publication history
Accepted:
January 5,
2023
Received:
January 5,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
