Clinical findings and respiratory function in infants following repair of oesophageal atresia and tracheo-oesophageal fistula

Abstract

Survival rates for infants undergoing surgical repair of oesophageal atresia with tracheo-oesophageal fistula (OA-TOF) have improved dramatically, but this condition remains associated with substantial morbidity. Most studies of patients following OA-TOF repair have concentrated on school-age and older people; whereas, the most hazardous period is infancy. We aimed to assess respiratory function in a group of infants following primary operative repair, and to relate the results to clinical findings during the first year of life. We studied 16 infants within 3 months of primary repair of OA-TOF. Measurements were made of maximum expiratory flow at functional residual capacity (VmaxFRC), thoracic gas volume (TGV) and airways resistance (Raw). Ten infants had tests repeated, usually to assess progress alongside continuing symptoms, or to ascertain improvement following additional surgery. Seven infants had essentially normal initial respiratory function tests, and six remained either symptom-free or developed only minor clinical problems. One infant subsequently developed stridor, with spontaneous improvement towards the end of the first year. The remaining nine infants had abnormal initial respiratory function tests: one was symptom-free at that time. The remainder developed respiratory and/or gastro-oesophageal symptoms. The functional abnormalities appeared to reflect the severity of the clinical problems encountered. We conclude that respiratory function testing in infants following OA-TOF repair may augment the value of clinical appraisal, help define postoperative respiratory status, and provide a general guide to likely clinical progress.

Bacterial Colonization of the Lower Airways in Children With Esophageal Atresia

“…Respiratory tract infections are common in EA patients. 1,[18][19][20] This may be explained by the colonization of the lower airways. The outcome of this study justifies early antibiotic treatment in EA patients with recurrent respiratory tract infections.…”

ERS International Congress 2023: highlights from the Paediatrics Assembly

“…Oesophageal atresia (OA) and tracheoeosophageal fistula (TOF) are congenital abnormalities that can affect 1:3500 live birth. Katie Rose (Liverpool, UK) [80] reported the data from 223 patients with a diagnosis of OA and TOF. Almost half of them had been followed up and 49 patients (22%) had documented spirometry, with 13 (6%) having more detailed lung function.…”

Pulmonary function of children with tracheomalacia and associated clinical factors

“…[5][6][7][8][9][10] Another possible spirometry-derived indicator of TM may include the Empey Index [EI = ratio of forced expired volume in 1 s (FEV 1 ) to peak expiratory flow (PEF)] which reflects upper airway obstruction. 11 Other PFT abnormalities reported in children with TM included variations in tidal end-expiratory flow, 12 maximum expiratory flow at functional residual capacity, [13][14][15] ratio of forced to tidal flows at mid-tidal volume, 13 thoracic gas volume, 14 and pulmonary resistance. 14,16 All the studies of complex PFTs were small and used a vague definition of TM; and some were undertaken in infants using chest squeeze.…”

“…11 Other PFT abnormalities reported in children with TM included variations in tidal end-expiratory flow, 12 maximum expiratory flow at functional residual capacity, [13][14][15] ratio of forced to tidal flows at mid-tidal volume, 13 thoracic gas volume, 14 and pulmonary resistance. 14,16 All the studies of complex PFTs were small and used a vague definition of TM; and some were undertaken in infants using chest squeeze. In addition, none of the studies evaluated whether PFTs indices related to bronchoscopic TM characteristics (e.g., severity).…”