Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity
Importance: Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients.Objective: Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atre...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2018.00401/full |
| _version_ | 1828978679708909568 |
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| author | Andrea Conforti Laura Valfrè Marianna Scuglia Marilena Trozzi Duino Meucci Stefania Sgrò Sergio Bottero Pietro Bagolan |
| author_facet | Andrea Conforti Laura Valfrè Marianna Scuglia Marilena Trozzi Duino Meucci Stefania Sgrò Sergio Bottero Pietro Bagolan |
| author_sort | Andrea Conforti |
| collection | DOAJ |
| description | Importance: Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients.Objective: Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atresia and/or tracheoesophageal fistula (EA/TEF). Analysis of the impact of those airway anomalies in early post-operative outcomes was performed.Patients and Methods: This was a review of a prospectively collected database, including patients from January 2008 to December 2017. Patients enrolled in the present study were treated in a high-volume referral center. Present study included all newborn-infants consecutively treated for EA/TEF. All patients were evaluated by flexible laryngotracheoscopy performed under local anesthesia in spontaneous breathing. In case of airway malformation suspected during flexible endoscopy, a rigid endoscopy was performed to complete airway assessment. If post-operative respiratory symptoms (noisy breathing, respiratory difficulty, failure to extubate, or difficulty feeding) were noted, a second laryngotracheoscopy was performed. Primary study outcome was to evaluate the prevalence of LTA in EA/TEF infants, characterizing of LTA, and their impact on early post-operative outcomes. Those primary study outcomes were planned before data collection began.Results: During the study period 207 patients with EA/TEF were treated. LTA had a period prevalence of 40.1% (83/207). Although no differences were recorded in terms of demographics and clinical presentation, LTA+ infants more frequently required tracheostomy (12/52, 23% vs. 0/124, 0%; p 0.0001) and were at increased risk of death (12/83, 14% vs. 5/124, 4%; p 0.009) in comparison with EA/TEF without LTA.Conclusions: Present data suggest a high prevalence of congenital LTA in patients affected by EA. Most of the abnormalities are congenital and a high proportion of patients with LTA require a tracheostomy. Mortality significantly correlates with the presence of LTA. Systematic airway endoscopic preoperative evaluation has to be pushed forward to minimize LTA-related morbidity and mortality. |
| first_indexed | 2024-12-14T15:22:57Z |
| format | Article |
| id | doaj.art-643cfbc0e0b6423bbdae71acdb3b146d |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-14T15:22:57Z |
| publishDate | 2018-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-643cfbc0e0b6423bbdae71acdb3b146d2022-12-21T22:56:06ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602018-12-01610.3389/fped.2018.00401430233Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden EntityAndrea Conforti0Laura Valfrè1Marianna Scuglia2Marilena Trozzi3Duino Meucci4Stefania Sgrò5Sergio Bottero6Pietro Bagolan7Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, ItalyNeonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, ItalyNeonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, ItalyAirway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, ItalyAirway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, ItalyAnesthesiology Unit, Department of Anesthesiology, Bambino Gesù Children's Hospital, Rome, ItalyAirway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, ItalyNeonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, ItalyImportance: Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients.Objective: Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atresia and/or tracheoesophageal fistula (EA/TEF). Analysis of the impact of those airway anomalies in early post-operative outcomes was performed.Patients and Methods: This was a review of a prospectively collected database, including patients from January 2008 to December 2017. Patients enrolled in the present study were treated in a high-volume referral center. Present study included all newborn-infants consecutively treated for EA/TEF. All patients were evaluated by flexible laryngotracheoscopy performed under local anesthesia in spontaneous breathing. In case of airway malformation suspected during flexible endoscopy, a rigid endoscopy was performed to complete airway assessment. If post-operative respiratory symptoms (noisy breathing, respiratory difficulty, failure to extubate, or difficulty feeding) were noted, a second laryngotracheoscopy was performed. Primary study outcome was to evaluate the prevalence of LTA in EA/TEF infants, characterizing of LTA, and their impact on early post-operative outcomes. Those primary study outcomes were planned before data collection began.Results: During the study period 207 patients with EA/TEF were treated. LTA had a period prevalence of 40.1% (83/207). Although no differences were recorded in terms of demographics and clinical presentation, LTA+ infants more frequently required tracheostomy (12/52, 23% vs. 0/124, 0%; p 0.0001) and were at increased risk of death (12/83, 14% vs. 5/124, 4%; p 0.009) in comparison with EA/TEF without LTA.Conclusions: Present data suggest a high prevalence of congenital LTA in patients affected by EA. Most of the abnormalities are congenital and a high proportion of patients with LTA require a tracheostomy. Mortality significantly correlates with the presence of LTA. Systematic airway endoscopic preoperative evaluation has to be pushed forward to minimize LTA-related morbidity and mortality.https://www.frontiersin.org/article/10.3389/fped.2018.00401/fullesophageal atresiaesophageal atresia and tracheoesophageal fistulalaryngotracheal anomaliesairways abnormalietieslaryngobronchoscopytrachea abnormalities |
| spellingShingle | Andrea Conforti Laura Valfrè Marianna Scuglia Marilena Trozzi Duino Meucci Stefania Sgrò Sergio Bottero Pietro Bagolan Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity Frontiers in Pediatrics esophageal atresia esophageal atresia and tracheoesophageal fistula laryngotracheal anomalies airways abnormalieties laryngobronchoscopy trachea abnormalities |
| title | Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity |
| title_full | Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity |
| title_fullStr | Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity |
| title_full_unstemmed | Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity |
| title_short | Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity |
| title_sort | laryngotracheal abnormalities in esophageal atresia patients a hidden entity |
| topic | esophageal atresia esophageal atresia and tracheoesophageal fistula laryngotracheal anomalies airways abnormalieties laryngobronchoscopy trachea abnormalities |
| url | https://www.frontiersin.org/article/10.3389/fped.2018.00401/full |
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