Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2020 Dec;56(12):1929-1932. doi: 10.1111/jpc.15090. Epub 2020 Sep 4.
Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland.
Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed.
Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis.
High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.
气消科（ADCs）是一个多学科项目，为患有复杂先天性或后天性呼吸、吞咽和生长障碍的儿童提供治疗。我们的目的是描述在昆士兰州一家三级儿科中心开设的首个 ADC 就诊儿童的人口统计学、临床、病因和研究概况。
从 2018 年 8 月至 2019 年 12 月，昆士兰儿童医院的 ADC 转介的儿童被纳入研究。回顾性分析了临床、生长和肺功能参数、支气管镜和上消化道内镜检查结果、胸部影像学和合并症的数据。
在这 17 个月期间，56 名儿童（中位数（范围）年龄 4 岁（3 个月-15 岁）；18 名女性）参加了 ADC。46 名（82%）儿童以前患有食管闭锁伴气管食管瘘；其中 43 例为 C 型。3 名（5%）儿童的基础疾病分别为孤立性食管闭锁、先天性膈疝和先天性肺畸形，1 名儿童有修复的喉裂。21 名（38%）儿童存在椎体肛门气管食管肾肢体异常（VACTERL）/椎体肛门气管食管肾异常（VATER）综合征。生长良好（中位数体重和体重指数 z 分数分别为-0.63 和-0.48）。34 名（61%）儿童报告持续湿咳，12 名（21%）因下呼吸道感染需要住院治疗。14 名（25%）儿童胸部 CT 显示支气管扩张，33 名（59%）儿童有临床气管软化，21 名儿童支气管镜检查显示。15 名（27%）儿童有吞咽困难，11 名（20%）依赖胃造口喂养，5 名（9%）有活检证实的嗜酸性食管炎。
大量在 ADC 就诊的儿童有持续的呼吸道症状，导致慢性肺部化脓和支气管扩张。需要前瞻性研究这种治疗模式的潜在益处，以更好地了解结果。
