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Can 'long-gap' esophageal atresia be safely managed at home while awaiting anastomosis?
Dalal Aziz1, Dan Schiller, Justin T Gerstle
1Division of General Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Insights
Selected neonates with long gap esophageal atresia (EA) can receive safe home care while awaiting surgery. This approach eases hospital resource strain and family burden, demonstrating successful home management for EA patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Background:
- Long gap esophageal atresia (EA) often necessitates prolonged hospitalization for neonates awaiting surgical repair.
- Current management involves gastrostomy and proximal pouch drainage, posing risks like aspiration and requiring intensive nursing care.
- Prolonged inpatient stays strain healthcare resources and impact families significantly.
Observation:
- A study involving 5 neonates with long gap EA explored the feasibility of home-based management prior to definitive repair.
- Patients received care at home for 42 to 113 days, supported by nursing, suction equipment, gastrostomy feeding, and CPR training.
- The study included patients with pure EA and one with duodenal atresia, with gestational ages from 31 to 41 weeks.
Findings:
- Successful home treatment was achieved for all 5 patients awaiting esophageal anastomosis.
- Complications were minimal, including one case of ear infection and another with recurrent upper respiratory tract infections.
- Definitive repair occurred between 6 to 12 months of age, with gastrostomy performed within days of birth for all.
Implications:
- Home management is a viable and safe option for selected neonates with long gap EA, reducing hospitalization duration.
- Success hinges on motivated families and robust community healthcare support systems.
- This approach offers a potential solution to optimize resource allocation and improve family well-being during long-term neonatal care.
Background:
Neonates with "long gap" esophageal atresia (EA) are often managed with gastrostomy and tube drainage of the proximal pouch for a number of months while awaiting definitive repair. Because of the risk of aspiration and need for complex nursing care, most remain hospitalized during this time. However, prolonged hospitalization utilizes scarce resources and may be difficult for many families.
Methods:
The authors report on 5 patients who were treated successfully at home while awaiting esophageal anastomosis.
Results:
Four patients had pure EA (one had a duodenal atresia), and one had a distal fistula. Gestational ages ranged from 31 to 41 weeks. All had a gastrostomy within days of birth. Age at definitive repair ranged from 6 to 12 months. Time at home while awaiting anastomosis ranged from 42 to 113 days. Care at home included nursing care, suction equipment and training, gastrostomy feeding, and ability to perform cardiopulmonary resuscitation. The only complications noted while at home consisted of ear infection in one patient and recurrent upper respiratory tract infections in another patient.
Conclusions:
Selected patients with long gap esophageal atresia can be treated safely at home while awaiting esophageal anastomosis. Success of this approach depends on a motivated, reliable family, and adequate support from community health care providers.