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Initial evaluation of a multidisciplinary pediatric aerodigestive program in a Brazilian hospital: challenges and
Débora Bressan Pazinatto1, Maria Angela Bellomo Brandão1, Flávia Lima Peixoto Costa1
1Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
Insights
This study highlights dysphagia as a key issue in pediatric aerodigestive patients, emphasizing the need for pediatrician involvement and improved hospital policies for timely access to care and procedures.
Area of Science:
- Pediatric Medicine
- Gastroenterology
- Pulmonology
Background:
- Pediatric aerodigestive programs address complex conditions in children.
- Early characterization of patients is crucial for program development.
Purpose of the Study:
- Identify clinical and epidemiological features of early pediatric aerodigestive patients.
- Describe follow-up challenges and propose mitigation strategies.
Main Methods:
- Case series of the first 25 patients evaluated by a Brazilian aerodigestive team.
- Median follow-up of 37 months.
Main Results:
- The median age was 45.7 months; 80% had dysphagia, 68% chronic lung disease, and 72% had ≥3 comorbidities.
- Moderate to severe dysphagia affected 12 children, with 7 on exclusive oral diets.
- Feeding strategy changes were suggested for 56%; pHmetry was the most common exam, and gastrostomy had the longest waiting list.
Conclusions:
- Dysphagia is the primary concern in this pediatric aerodigestive cohort.
- Enhanced pediatrician involvement and revised hospital policies are essential for optimal patient care and access to necessary interventions.
Objective:
To identify clinical and epidemiological characteristics of children evaluated by the pediatric aerodigestive program at the beginning of its activity, describe challenges in follow-up, and suggest mitigation strategies.
Methods:
A case series was conducted describing the first 25 patients discussed by the aerodigestive team from a Brazilian quaternary public university hospital between April 2019 and October 2020. The median follow-up was 37 months.
Results:
During the study period 25 children were seen by the group and the median age at first assessment was 45.7 months old. Eight children had a primary airway abnormality, five had a tracheostomy. Nine children had genetic disorders and one had esophageal atresia. Dysphagia was present in 80% of the patients, 68% had a history of chronic or recurrent lung disease, 64% had a gastroenterological diagnosis and 56% had neurological impairment. Moderate to severe dysphagia was identified in 12 children and 7 of these had an exclusive oral diet at the time. The majority of children (72%) had 3 or more comorbidities. Following team discussion, a change in feeding strategy was suggested in 56% of the children. The most frequently ordered exam was pHmetry (44%) and gastrostomy was the surgical procedure with the longest waiting list.
Conclusions:
Dysphagia was the most frequent issue encountered in this initial group of aerodigestive patients. Pediatricians caring for these children must be involved in aerodigestive team discussions and hospital policies must be revised to facilitate access to exams and procedures needed for this population.
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