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Growth and Development Assessment of Children (1-5 Years) Operated for Tracheoesophageal Fistula/Esophageal Atresia:
Monika Maan1, Sukhwinder Kaur1, Geetanjli Kalyan1
1National Institute of Nursing Education, PGIMER, Chandigarh, India.
Insights
Children operated for esophageal atresia (EA) and tracheoesophageal fistula (TEF) show significant growth delays and developmental deficits compared to healthy peers. Early monitoring is crucial for these congenital anomaly survivors.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Developmental Pediatrics
Background:
- Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a common and severe congenital anomaly in children.
- Surgical intervention is required in the neonatal period, but postsurgical complications can lead to poor growth and developmental outcomes.
- Children operated for EA/TEF often experience adverse effects in early childhood, necessitating close monitoring.
Purpose of the Study:
- To assess and compare the growth and development of children aged 1-5 years who underwent surgery for TEF/EA.
- To compare the outcomes of operated children with a healthy control group.
Main Methods:
- A case-control study involving 40 children aged 1-5 years who had undergone TEF/EA repair and age-matched healthy controls.
- Data collection included socio-demographic and clinical profiles, using the Trivandrum Development Screening chart and Vineland Social Maturity Scale.
Main Results:
- A majority of children (82.5%) had distal TEF, with 70% undergoing primary repair.
- Postoperative complications included respiratory infections (35%), anastomosis leakage (30%), and GER (15%).
- Operated children showed significantly lower height-for-age, weight-for-height, and social maturity compared to controls.
Conclusions:
- Children operated for TEF/EA exhibit significant growth deficits, with over a fourth being underweight and stunted, and over a third being wasted.
- Developmental delays were observed in the operated group compared to healthy children.
- Continuous growth monitoring and developmental assessment are vital for children post-TEF/EA repair.
Introduction:
Among children, esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is one of the major and common congenital anomalies. It is a life-threatening emergency and at birth may be associated with three C's coughing, choking, and cyanosis. It requires surgical interventions in the early neonatal period. The postsurgical period is associated with poor growth which can be developmental outcomes particularly in the first 5 years of life and attributed to postsurgical complications. The aim of the study is to assess and compare the growth and development of the children (1-5 years) operated for TEF/EA attending Pediatric Surgery OPD/admitted inwards at APC, PGIMER, Chandigarh versus healthy controls.
Materials And Methods:
A case-control study was conducted on age-matched 40 children aged between 1 and 5 years operated for TEF/EA and healthy controls. The sampling technique for cases was total enumeration and for controls was purposive sampling. Tools used were socio-demographic sheets of children, clinical profile of children, Trivandrum Development Screening chart, and Vineland Social Maturity Scale for Indian adaptation.
Results:
Majority 33 (82.5%) of children had distal TEF and more than two-third 28 (70%) have undergone primary repair. More than one-third 14 (35%) had a respiratory infection, 12 (30%) anastomosis leakage and 6 (15%) had Gastroesophageal reflux (GER) as one of the early and late postoperative complications. More than one-fourth 11 (27.5%) of TEF/EA operated children had less weight, 11 (30%) had less height and 16 (40%) had less weight for height for their reference age. A significant difference was found for height for age, weight for height, and social maturity among children who had TEF repair as compared to their healthy counterparts.
Conclusion:
Growth monitoring reflected (more than one-fourth of children were underweight and stunted while more than one-third were wasted) and showed development delay in TEF/EA operated children as compared to healthy controls.
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