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Early Otolaryngology Evaluation Advised for Neonates with Esophageal Atresia/ Tracheoesophageal Fistula

by Linda Kossoff •

To what extent are secondary upper aerodigestive tract (UADT) sequelae evidenced in neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF)?

BOTTOM LINE

Patients with EA/TEF frequently have aerodigestive sequelae, suggesting the need for early otolaryngology evaluation in their care.

BACKGROUND: Today’s patients with EA/TEF are likely to survive this rare and complex condition, but aerodigestive complications in their first years of life are common. Moreover, initial diagnosis or persistence of disease can occur throughout adulthood. Understanding the natural history of respiratory complications in patients with EA/TEF would optimize their otolaryngologic care.

COMMENT: This article lends credence to the idea that all patients with EA/TEF should have otolaryngology evaluation due to the high co-occurrence of upper aerodigestive findings. In their review of 2,509 patients across 47 hospitals, the authors identified that 77.4% required an aerodigestive procedure, including 65% that required DLBs. It isn’t uncommon in many centers that peds surgery handles these cases alone and does not refer immediately to (or involve) otolaryngology in the OR evaluation or surgical management. —Eric Gantwerker, MD

STUDY DESIGN: Retrospective cohort study.

SETTING: Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio.

SYNOPSIS: Researchers identified 2,509 patients with EA/TEF from 47 hospitals. Of all patients, 41.6% were delivered preterm (<37 weeks), 9.9% were of very low birth weight (<1,500 g), 1,943 had at least one of the evaluated aerodigestive procedures within up to 14 admissions, and 1,145 required major surgical intervention. Researchers found no significant difference in incidence of UADT procedures between males and females. Preterm gestation increased the odds of undergoing tracheostomy, and very low birth weight increased the odds of having gastrostomy tube placement. Authors note that, overall, just 53.1% of the cohort underwent diagnostic direct laryngoscopy and/or bronchoscopy, suggesting that nearly 46% of patients with EA/TEF did not receive otolaryngologic airway evaluation at the time of repair. The mortality rate was 5.8% during the entire follow-up period of up to 14 years. Authors say these data suggest that UADT pathology must be considered when managing patients with EA/TEF, and that many of these patients would benefit from the earliest possible evaluation. Study limitations included use of an administrative database composed of tertiary pediatric hospitals.

CITATION: Patterson K, Beyene TJ, Asti L, et al. Quantifying upper aerodigestive sequelae in esophageal atresia/tracheoesophageal fistula neonates. Laryngoscope.2022;132:695-700.