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Long-term pulmonary function in esophageal atresia-A case-control study
Rikke N Pedersen1, Simone Markøw1, Søren Kruse-Andersen2
1Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
Insights
Children with esophageal atresia (EA) show significantly reduced lung function and increased respiratory issues. These pulmonary complications persist into adolescence, highlighting the long-term impact of this congenital anomaly.
Area of Science:
- Pediatric Pulmonology
- Congenital Anomalies
- Respiratory Medicine
Background:
- Esophageal atresia (EA) is a congenital condition frequently leading to significant pulmonary morbidity in children.
- Long-term respiratory health in individuals with surgically corrected EA requires thorough evaluation.
Purpose of the Study:
- To assess pulmonary complications in children and adolescents aged 5–15 years with surgically corrected EA.
- To compare lung function parameters between EA patients and a control group.
Main Methods:
- A cohort of 59 children with EA underwent clinical interviews, spirometry, body plethysmography, and mannitol challenge tests.
- Pulmonary function tests included diffusion capacity, airway resistance, fractional exhaled nitric oxide, and serum specific IgE.
- A control group of 25 children with gastroesophageal reflux disease was included for comparison.
Main Results:
- Over half of EA patients reported respiratory symptoms (55.9%), recurrent pneumonia (53.4%), or frequent cough (54.2%).
- EA patients exhibited significantly lower Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Forced Expiratory Fraction 25-75% (FEF25-75%) compared to controls.
- Total lung capacity (TLC) was also diminished in EA patients. Obstructive ventilatory impairment affected 28.8% of EA patients, while 17.3% had restrictive impairment.
Conclusions:
- Children and adolescents with EA demonstrate significantly impaired pulmonary function.
- Restrictive ventilatory impairment in EA patients may result from impaired lung growth post-thoracotomy.
- No single factor was identified as a predictor of ventilatory impairment in this EA cohort.
Background:
Esophageal atresia (EA) is a congenital anomaly associated with substantial pulmonary morbidity throughout childhood.
Aim:
The aim of this study was to evaluate pulmonary complications among 59 five to 15-year-old children and adolescents with surgically corrected congenital EA.
Methods:
Participants underwent a structured interview, spirometry, body plethysmography, mannitol challenge test, skin prick test, as well as measurements of the diffusion capacity, airway resistance, fraction of exhaled NO, and specific immunoglobulin E in serum. A control group consisted of 25 children being evaluated for gastroesophageal reflux disease.
Results:
Among the EA patients 33 (55.9%) had respiratory symptoms, 31 (53.4%) had a history of at least three pneumonias, and 32 (54.2%) reported more frequent cough episodes than peers. The Forced Vital Capacity (FVC) was 84.9% ± 13.2% of predicted, forced expiratory volume 1 sec (FEV1) was 78.2% ± 12.4% of predicted, and forced expiratory fraction 25-75% (FEF25-75%) was 71.5 ± 17.8% of predicted in EA patients, lower than disease controls (P < 0.0001 for all). In addition, the total lung capacity (TLC) was lower in patients with EA than in the controls (P < 0.0001). Fifteen patients (28.8%) with EA had obstructive ventilatory impairment, compared to nine patients (17.3%) with restrictive ventilatory impairment, while one had a combination.
Conclusions:
The present study demonstrated significantly decreased pulmonary characteristics in EA patients. Restrictive ventilatory impairment occurring in EA is probably due to poor lung growth after thoracotomy. No single factor predicted ventilatory impairment in children and adolescents with EA. Pediatr Pulmonol. 2017;52:98-106. © 2016 Wiley Periodicals, Inc.
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