Esophageal atresia: long-term interdisciplinary follow-up

Abstract

Background: We provide protocolized interdisciplinary follow-up to babies born with Esophageal Atresia (EA). There are few reports in Argentina about follow-up of EA patients. Objective: To describe outcomes in follow-up of EA patients at 1, 3 and 6 years old and to compare outcomes at age 1 with those at age 6. Methods: Prospective, longitudinal, analytic study of the cohort of babies born with EA, admitted to the follow-up program from 11/01/03 to 10/31/14. Follow-up includes: growth (weight > 10 th centile, WHO), neurology-psychomotor development, audiology, vision, genetic, mental health, surgical reintervention, phonostomatology, language, pulmonology, re-hospitalization for clinical causes, lost to follow-up. Outcomes were described at age 1, 3 and 6. We included all EA patients who had reached age 1 at the start of this study. Results: 27 babies were admitted; 30% had long-gap EA; 18% presented VACTERL association; 23 children met inclusion criteria. Genetics was assessed in 18 newborns (78%); a chromosomal map was performed in 11 babies; 3 had an abnormal karyotype. Mental health: 5/14 of the assessed children showed problems. Phonostomatology: 11 newborns checked (6 required treatment, 4 recovered at age 1). Pulmonologist evaluated 18 babies (7 with recurrent wheezing, 6 with moderate tracheomalacia). Gastroenterology and endoscopy: 80% presented gastroesophageal reflux (GER) grade 3-4, and 50% showed a pathologic pHmetry. Lost to follow-up: age 1, 2 (8%); age 3, 3 (17%); age 6, 3 (23%). Normal outcomes observed are the following. Age 1 – growth: 81%; neurologic-psychomotor developmental index (NPDI): 76%; audiology: 95%; vision: 85%; language: 62%; re-hospitalization for clinical causes: 38%; surgical reinterventions: 47%. Age 3 – growth: 78%; NPDI: 50%; audiology: 93%; vision: 93%; language: 43%; re-hospitalization: 35%; surgical reinterventions: 14%. Age 6 – growth: 50%; NPDI: 30%; audiology: 90%; vision: 40%; language: 50%; re-hospitalization for clinical causes: 0; surgical reinterventions: 7%. Conclusions: Patients with EA are at risk for long-term morbidity and impairments. Long-term follow-up should be warranted for them.