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Aerodigestive Clinics as Emerging Pediatric Care Model: The First 100 Patients in Israel
Yulia Gendler1, Emmanuelle Seguier-Lipszyc2,3, Ari Silbermintz4
1Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel.
Insights
The first pediatric aerodigestive center in Israel provides coordinated care for complex pediatric aerodigestive disorders. This multidisciplinary approach improved patient outcomes and achieved high parental satisfaction.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Pulmonology
- Pediatric Surgery
- Healthcare Management
Background:
- Aerodigestive clinics utilize interdisciplinary teams for complex care coordination and combined endoscopies.
- Establishing specialized centers is crucial for managing children with aerodigestive conditions.
Purpose of the Study:
- To detail the establishment and patient demographics of Israel's inaugural pediatric aerodigestive center.
- To evaluate the initial cohort and interventions at a new tertiary pediatric aerodigestive clinic.
Main Methods:
- Retrospective single-center cohort study of patients from January 2017 to June 2020.
- Analysis of patient data including diagnoses, procedures, and parental satisfaction.
- Involved combined respiratory and digestive (NoAM) clinic at Schneider Children's Medical Center of Israel.
Main Results:
- 100 pediatric patients with aerodigestive disorders were evaluated.
- Common conditions included esophageal atresia, tracheoesophageal fistula, genetic disorders, and airway abnormalities.
- Procedures like triple endoscopy and esophageal dilatation were performed, with 6 patients undergoing posterior tracheopexy and symptom improvement.
Conclusions:
- A coordinated, multidisciplinary approach is essential for optimal care of pediatric aerodigestive disorders.
- Cross-disciplinary collaboration fosters high-quality, innovative patient care.
- Defining outcome measures is necessary for objectively assessing clinical benefits.
Background:
Aerodigestive clinics are run by interdisciplinary medical and surgical teams, and provide complex care coordination and combined endoscopies.
Objectives:
To describe the design and patient population of the first pediatric aerodigestive center in Israel.
Methods:
A retrospective single-center cohort study was conducted describing patients followed in the aerodigestive clinic of Schneider Children's Medical Center of Israel, a tertiary pediatric hospital, between its inception in January 2017 and June 2020.
Results:
During the study period, 100 patients were seen at the combined respiratory and digestive (NoAM) clinic, with a total of 271 visits. Median age at first assessment was 29.5 months (range 3-216). Fifty-six patients (56%) had esophageal atresia and tracheoesophageal fistula. Thirty-nine patients had an identified genetic disorder, 28 had a primary airway abnormality, 28 were oxygen dependent, and 21 were born premature. Fifty-two patients underwent triple endoscopy, consisting of flexible bronchoscopy, rigid bronchoscopy, and gastroscopy. In 33 patients, esophageal dilatation was necessary. Six patients underwent posterior tracheopexy at a median of 6 months of age (range 5 days to 8 years) all with ensuing symptom improvement. The total mean parental satisfaction score on a Likert-type scale of 1-5 (5 = highest satisfaction) was 4.5.
Conclusions:
A coordinated approach is required to provide effective care to the growing population of children with aerodigestive disorders. The cross fertilization between multiple disciplines offers a unique opportunity to develop high quality and innovative care. Outcome measures must be defined to objectively measure clinical benefit.
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