Cough in the child with esophageal atresia with or without tracheo-esophageal fistula.
Respiratory symptoms often complicate congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF).
Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The study describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient’s needs and harmonize the care. A retrospective single centre experience data collection was performed and 105 children were included. 66% of children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years. Recurrent pneumonia (33%) and wheezing (31%) were the most reported symptoms. The first respiratory evaluation was performed after excluding digestive problems at mean age of 3.9 ± 4.2 years. Twenty nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41%), residual tracheal diverticulum (34%), bronchiectasis (31%), tracheal vascular compression (21%), tracheomalacia (17%) and esophageal diverticulum (14%). Fifty three patients have undergone to airways endoscopy detecting tracheomalacia (66%), residual tracheal diverticulum (26%), recurrent tracheoesophageal fistula (19%) and vocal cord paralysis (11%). The study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work up must be considered to improve respiratory long term outcome in this group of patients.
F. Porcaro, L. Valfré, L. Rotondi Aufiero, L. Dall’Oglio, P. De Angelis, A. Villani, P. Bagolan, S. Bottero, R. Cutrera. Respiratory problems in children with esophageal atresia and tracheoesophageal fistula. Ital J Pediatr. 2017; 43(1): 77.