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Published on: February 14, 2019
Multidisciplinary approach to paediatric aerodigestive disorders: A single-centre longitudinal observational study
Amol Fuladi1, Sadasivam Suresh1, Rahul Thomas1
1Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Insights
Children attending aerodigestive clinics (ADCs) often have complex respiratory issues like chronic cough and bronchiectasis. Further prospective studies are needed to confirm the benefits of this multidisciplinary care model for pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Clinical Care Models
Background:
- Aerodigestive clinics (ADCs) provide multidisciplinary care for children with complex breathing, swallowing, and growth issues.
- Understanding the profile of children attending these clinics is crucial for optimizing care.
Purpose of the Study:
- To describe the demographic, clinical, etiological, and investigational characteristics of children at an inaugural pediatric aerodigestive clinic.
- To establish a baseline profile for future outcome assessments.
Main Methods:
- Retrospective analysis of 56 children referred to the Queensland Children's Hospital ADC between August 2018 and December 2019.
- Data collected included clinical parameters, growth, lung function, endoscopy findings, imaging, and comorbidities.
Main Results:
- The majority of children had a history of esophageal atresia with tracheo-esophageal fistula (82%) or VACTERL/VATER association (38%).
- Many presented with ongoing respiratory symptoms (61% wet cough), bronchiectasis (25%), or tracheomalacia (59%).
- Adequate growth was observed, but significant feeding difficulties (20% gastrostomy dependent) and eosinophilic esophagitis (9%) were noted.
Conclusions:
- Children attending ADCs frequently experience persistent respiratory symptoms leading to chronic lung issues like bronchiectasis.
- Prospective studies are essential to evaluate the long-term benefits and effectiveness of the ADC model of care.
Aim:
Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland.
Methods:
Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed.
Results:
Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis.
Conclusion:
High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.
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