Abstract
Children born with esophageal atresia (EA) might suffer from significant oral feeding problems which could evolve into tube dependency. The primary aim of the study was to define the outcome of tube weaning in children after successful EA repair and to compare outcomes in children with short gap/TEF (tracheoesophageal fistula) and long-gap EA. Data of 64 children (28 with short-gap EA/TEF with primary anastomosis and 36 with long-gap EA with delayed surgical repair) who participated in a standardized tube weaning program based on the “Graz model of tube weaning” (in/outpatients in an intensive 3-week program, online coaching (Netcoaching) only, or a combined 2-week intensive onsite followed by online treatment “Eating School”) from 2009 to 2019 was evaluated. Sixty-one patients completed the program by transitioning to exclusive oral intake (95.3%). Three children (4.7%) were left partially weaned at the time of discharge. No significant differences could be found between short gap/TEF and long-gap EA group regarding outcomes.Conclusions: The study’s findings support the efficacy of tube weaning based on the published “Graz model of tube weaning” for children born with EA/TEF and indicate the necessity of specialized tube weaning programs for these patients.What is Known:• Children with esophageal atresia/tracheoesophageal fistula often suffer from feeding problems and tube dependency.• Different tube weaning programs and outcomes have been published, but not specifically for children with EA.What is New:• Evaluation of a large sample of children referred for tube weaning after EA repair.• Most children with EA can be weaned off their feeding tubes successfully after attending a specialized tube weaning program.
Highlights
Esophageal atresia (EA) represents a congenital defect caused by abnormal embryological maturation of the upper gut/ foregut leading to a blind-ending pouch and missing connection between the esophagus and the stomach
The study’s findings support the efficacy of tube weaning based on the published “Graz model of tube weaning” for children born with EA/tracheoesophageal fistula (TEF) and indicate the necessity of specialized tube weaning programs for these patients
Children with esophageal atresia/tracheoesophageal fistula often suffer from feeding problems and tube dependency
Summary
Esophageal atresia (EA) represents a congenital defect caused by abnormal embryological maturation of the upper gut/ foregut leading to a blind-ending pouch and missing connection between the esophagus and the stomach. In children with isolated EA/TEF, the survival rate is high (approaching 100%) [1] Children with comorbidities such as prematurity, low birth weight, or additional congenital anomalies show higher mortality rates [1]. While short gap/TEF is usually reconstructed primarily by anastomosing both ends, special techniques are used to establish intestinal continuity in children with long-gap EA with no fistula [2]. Elongation procedures, such as repetitive bouginage, Kimura, or traction sutures, as proposed by Dr Foker, aim to elongate both esophageal ends until a delayed primary anastomosis is feasible [3]. Motility problems are quite frequent in children with esophageal atresia [6]
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