Aerodigestive Programs Enhance Outcomes in Pediatric Patients

Wootten, Christopher T.; Belcher, Ryan; Francom, Christian R.; Prager, Jeremy D.

doi:10.1016/j.otc.2019.06.007

Cited by 23 publications

(19 citation statements)

References 30 publications

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“…Many studies have shown that offering a coordinated care to these children in the form of aerodigestive clinic (ADC) not only facilitates the clinical care but also improves the overall outcomes. [5][6][7][8][9] Similar approach has changed our practice in management of other chronic conditions such as obesity, asthma, diabetes and cystic fibrosis. 5 With this view of improving the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth, an ADC was established in 2018 at our paediatric tertiary care centre in Queensland.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…This warrants for an interdisciplinary coordinated clinic care approach. Many studies have shown that offering a coordinated care to these children in the form of aerodigestive clinic (ADC) not only facilitates the clinical care but also improves the overall outcomes 5–9 . Similar approach has changed our practice in management of other chronic conditions such as obesity, asthma, diabetes and cystic fibrosis 5 …”

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confidence: 99%

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Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Fuladi

Suresh

Thomas

et al. 2020

J Paediatrics Child Health

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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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Section: What This Paper Addsmentioning

confidence: 99%

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confidence: 99%

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Fuladi

Suresh

Thomas

et al. 2020

J Paediatrics Child Health

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“…Several researchers have reported positive clinical outcomes in patients treated by ADTs [ 5 , 6 ]. Furthermore, it has been reported that ADTs can reduce unnecessary tests, medical costs, risks, and time for diagnoses [ 7 , 8 ]. The first aerodigestive multidisciplinary program was initiated at Cincinnati Children’s Hospital in the United States in 1999 [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

et al. 2021

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We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.

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“…Preoperative planning and management of patients who require laryngotracheal reconstruction (LTR) due to airway narrowing has evolved over time with an increased emphasis on multidisciplinary team approach. In recent years, multidisciplinary aerodigestive centers have increased in the United States of America and world 1 . These teams often include otolaryngology, pulmonology, gastroenterology, speech language pathology, and social work.…”

Section: Introductionmentioning

confidence: 99%

“…These teams often include otolaryngology, pulmonology, gastroenterology, speech language pathology, and social work. Preoperative assessment often involves testing for and management of gastroesophageal reflux, eosinophilic esophagitis, aspiration, asthma, bronchitis, and chronic lung disease 1, 2 …”

Section: Introductionmentioning

confidence: 99%

Impact of Pre‐operative Multidisciplinary Evaluation on Laryngotracheal Reconstruction Outcomes

et al. 2020

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Objective/Hypothesis Determine if diagnostic findings from pre‐operative multidisciplinary evaluations are associated with single surgery or overall success rates in pediatric laryngotracheal reconstruction (LTR). Study Design Retrospective cohort. Methods Retrospective cohort study of patients undergoing LTR at a tertiary care children's hospital between January 01, 2008 and December 31, 2017. Success is defined as decannulation rate if tracheostomy present, and resolution of symptoms if tracheostomy not present. Cohorts compared were those who did and did not receive pulmonary and gastrointestinal preoperative testing. Multivariate, logistic regression, and Kaplan Meier analyses performed. Results About 165 children were included in the study. Median age was 3 years at the time of surgery; 73% of LTRs were double‐stage procedures. Single surgery and overall success rates were 75% and 87%, respectively. After adjusting for severity of stenosis and surgical approach, performing esophagogastroduodenoscopy (EGD) and normal gross appearance on EGD were associated with increased single surgery (P = .01, .005) and overall success (P = .005, .0003). Performing pH probe and normal EGD biopsy results was associated with increased overall success (P = .03, .007). Asthma and musculoskeletal comorbidities, postoperative complications, and need for postoperative balloon dilation were associated with decreased success. No other comorbidities evaluated impacted success. Conclusions Aerodigestive comorbidities are common in children undergoing LTR, and preoperative multidisciplinary workup often results in changes in management. After adjusting for grade and level of stenosis and staged approach, performing EGD and pH/impedance probe as well as normal gross and microscopic EGD findings was independently associated with increased LTR surgical success. Level of Evidence 4 (retrospective cohort study) Laryngoscope, 131:E2356–E2362, 2021

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Aerodigestive Programs Enhance Outcomes in Pediatric Patients

Cited by 23 publications

References 30 publications

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

Impact of Pre‐operative Multidisciplinary Evaluation on Laryngotracheal Reconstruction Outcomes

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