Respiratory morbidity after repair of oesophageal atresia and tracheo-oesophageal fistula.

Abstract

Respiratory morbidity in 334 patients aged 1 to 37 years with repaired oesophageal atresia and tracheo-oesophageal fistula is reported. Just under half the patients were subsequently hospitalised with respiratory illness. Two thirds of admissions were before 5 years of age. Five percent were admitted on more than five occasions. Patients with gastrooesophageal reflux and low birth weight were more likely to be admitted. Thirty one percent of patients had one or more episodes of pneumonia in the first five years of life and 5% after 15 years. The prevalence of annual bouts of bronchitis in these age groups was 74% and 41% respectively. The prevalence of wheeze was about 40% in all age groups. Patients with symptoms persisting after 15 years were more likely to have had lower respiratory tract illness in early childhood and a history of atopy. In the 12 months before review, weekly episodes of wheezing were present in one third under 5 years and 15% over 15 years. Thirty two percent of patients aged 5-10 years and 8% over 15 years missed two or more weeks of school or work in the previous year with respiratory illness. (Arch Dis Child 1993;68:167-70)

Respiratory function in childhood following repair of oesophageal atresia and tracheoesophageal fistula

“…6 These may be multifactorial in origin and relate to recurrent inhalation, defective oesophageal motility, bronchial obstruction (not necessarily asthma), and tracheomalacia. We found a lower incidence of recurrent bronchitis than previously reported 3.…”

Recommendations for the assessment and management of cough in children

“…A brassy, barking or croupy cough is suggestive of tracheal or glottic irritation and children appeared distressed with the cough 80 – 86. A “seal-like” barking or brassy cough which is particularly severe with concomitant viral upper respiratory infection occurs in children with tracheal compressive lesions or in those with tracheomalacia, including the so-called “TOF cough” following repair of a tracheo-oesophageal fistula.…”

Oesophageal atresia and tracheo-oesophageal fistula

“…Recurrent chest infections-bronchitis and pneumonia-occur in up to two thirds of TOF survivors in the early years of life. 36 Repeated infections or aspiration may lead to irreversible lung damage with bronchiectasis and persistent lobar collapse. Wheeze occurs in 40% of survivors, and tends not to improve with age.…”