Malnutrition and Feeding Problems in Children with Esophageal Atresia

Document Type : Research Paper

Authors

1 Associate Professor, Pediatric Ward, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Assistant Professor, Pediatric Ward, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

4 Associate Professor, Pediatric Ward, Amir-Al-Momenin Hospital, Zabol University of Medical Sciences, Zabol, Iran

5 Department of Hematology, Faculty of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran

6 Department of Pediatrics and Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran

Abstract

Introduction: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is defined as a congenital malformation characterized with the interruption or obstruction of esophagus. Affected neonates may present with cyanosis during breast feeding, sialorrhea, coughing and difficulty in respiration. The defect should be corrected by surgery; otherwise, the condition can be life-threatening. Little is known about the long-term nutritional problems of children with EA. Our aim was to assess growth status and nutritional difficulties in children with EA. Methods: This was a retrospective study on 32 children with EA between 2007 and 2016. Nutritional status and feeding problems were assessed by a questionnaire. Results: The most common EA-associated complications were esophageal stricture (84.4%), dysphagia (46.9%), gastroesophageal reflux disease (37.5%), and respiratory infections (25%). Majority of our patients showed normal growth parameters, and 96.9% of them had experienced at least one complication or feeding problem including needing to drink water to swallow food (25%), coughing during feeding (34.4%), vomiting (12.5%), and abdominal pain (34.4%). There were no significant associations between feeding problems and growth parameters. Conclusions: Feeding problems are relatively common in children with EA. There is a need to provide nutritional consults to these patients to prevent or mitigate these problems.

Keywords


1.    Kovesi T, Rubin S. Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest. 2004; 126(3): 915-25.
2.    Rayyan M, Rommel N, Tack J, Deprest J, Allegaert K. Esophageal Atresia: Future Directions for Research on the Digestive Tract. Eur J Pediatr Surg. 2017; 27(4): 306-12.
3.    Koziarkiewicz M, Taczalska A, Jasinska-Jaskula I, Grochulska-Cerska H, Piaseczna-Piotrowska A. Long-term Complications of Congenital Esophageal Atresia, Single Institution Experience. Indian Pediatr. 2015; 52(6): 499-501.
4.    Deurloo JA, Ekkelkamp S, Schoorl M, Heij HA, Aronson DC. Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg. 2002; 73(1): 267-72.
5.    Ioannides AS, Copp AJ. Embryology of oesophageal atresia. Semin Pediatr Surg. 2009; 18(1): 2-11.
6.    Morini F, Conforti A, Bagolan P. Perioperative Complications of Esophageal Atresia. Eur J Pediatr Surg. 2018; 28(2): 133-40.
7.    Pedersen RN, Calzolari E, Husby S, Garne E ; EUROCAT Working group. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child. 2012; 97(3): 227-32.
8.    Konkin DE, O’Hali WA, Webber EM, Blair GK. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2003; 38(12): 1726-9.
9.    Andrassy RJ, Patterson RS, Ashley J, Patrissi G, Mahour GH. Long-term nutritional assessment of patients with esophageal atresia and/or tracheoesophageal fistula. J Pediatr Surg. 1983; 18(4): 431-5.
10.  Rintala RJ, Sistonen S, Pakarinen MP. Outcome of esophageal atresia beyond childhood. Semin Pediatr Surg. 2009; 18: 50-6.
11.  Little DC, Rescorla FJ, Grosfeld JL, West KW, Scherer LR, Engum SA. Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2003; 38(6): 852-6.
12.  Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008; 14(2): 118-27.
13.  Peters RT, Ragab H, Columb MO, Bruce J, MacKinnon RJ, Craigie RJ. Mortality and morbidity in oesophageal atresia. Pediatr Surg Int. 2017; 33(9): 989-94.
14.  Puntis JW, Ritson DG, Holden CE, Buick RG. Growth and feeding problems after repair of oesophageal atresia. Arch Dis Child. 1990; 65(1): 84-8.
15.  Volkert VM, Piazza CC. Pediatric feeding disorders. Handbook of evidence-based practice in clinical psychology. 2012.
16.  Rommel N, De Meyer AM, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003; 37(1): 75-84.
17.  Chetcuti P, Phelan PD. Gastrointestinal morbidity and growth after repair of oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child. 1993; 68(2): 163-6.
18.  Ramsay M, Birnbaum R. Feeding difficulties in children with esophageal atresia: treatment by a multidisciplinary team. Dis Esophagus. 2013; 26(4): 410-2.
19.  Menzies J, Hughes J, Leach S, Belessis Y, Krishnan U. Prevalence of malnutrition and feeding difficulties in children with esophageal atresia. J Pediatr Gastroenterol Nutr. 2017; 64(4): e100-5.
20.  Seo J, Kim DY, Kim AR, Kim DY, Kim SC, Kim IK, et al. An 18-year experience of tracheoesophageal fistula and esophageal atresia. Korean J Pediatr. 2010; 53(6): 705-10.
21.  Lacher M, Froehlich S, Von Schweinitz D, Dietz HG. Early and long term outcome in children with esophageal atresia treated over the last 22 years. Klin Padiatr. 2010; 222(5): 296-301.
22.  Legrand C, Michaud L, Salleron J, Neut D, Sfeir R, Thumerelle C, et al. Long-term outcome of children with oesophageal atresia type III. Arch Dis Child. 2012; 97(9): 808-11.
23.  Schmidt A, Obermayr F, Lieber J, Gille C, Fideler F, Fuchs J. Outcome of primary repair in extremely and very low-birth-weight infants with esophageal atresia/distal tracheoesophageal fistula. J Pediatr Surg. 2017; 52(10): 1567-70.
24.  Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd. Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg. 1995; 130(5): 502-8.