From Children's Hospital Colorado, Aurora, CO.
the Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO.
J Pediatr Gastroenterol Nutr. 2023 Mar 1;76(3):288-294. doi: 10.1097/MPG.0000000000003697. Epub 2022 Dec 28.
This study aimed to characterize feeding/swallowing difficulties in children with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) and evaluate associations among feeding difficulties, pharyngeal dysphagia (PD), and other aerodigestive evaluation findings.
This was a retrospective cohort study of feeding/swallowing characteristics of 44 patients with EA/TEF treated in the aerodigestive program of a single academic medical institution from 2010 to 2015. Demographics, comorbidities, presence and characteristics of feeding/swallowing difficulties, and results of relevant diagnostic tests [videofluoroscopic swallow studies (VFSS), clinical feeding evaluations (CFEs), chest computerized tomography (CT) scans, pulmonary bronchoscopies, and upper GI (UGI)/esophagrams] were reviewed.
Fifty percent of the cohort had PD and 88.6% had feeding difficulties. Across 118 encounters (87 VFSS and 31 CFEs), feeding difficulties suggestive of esophageal dysphagia were most frequently seen in children over 48 months and feeding difficulties suggestive of developmental feeding problems were most frequently seen in children from 24 to 48 months. Abnormal findings were present in 59.8% of VFSS, with aspiration (34.5%) and pharyngeal residue (26.4%) the most frequently observed signs of dysphagia. Abnormal UGI/esophagram findings were not associated with significantly increased risk of feeding difficulties during visits within 3 months (risk ratio, RR = 1.33). Presence of dysphagia was associated with increased risk for some abnormal CT findings (RR= 3.0 for airspace and 3.0 for bronchiectasis).
Feeding/swallowing difficulties are common in EA/TEF, and types of feeding difficulties vary by patient age. The presence of abnormal findings on UGI/esophagram did not increase the risk of feeding complaints; however, the presence of dysphagia increased the risk of abnormal chest CT.
本研究旨在描述食管闭锁和/或气管食管瘘（EA/TEF）患儿的喂养/吞咽困难，并评估喂养困难、咽部吞咽困难（PD）和其他气道-消化道评估结果之间的相关性。
这是一项回顾性队列研究，纳入了 2010 年至 2015 年期间在一家学术医疗机构的气道-消化道项目中接受治疗的 44 例 EA/TEF 患儿的喂养/吞咽特征。回顾了人口统计学资料、合并症、喂养/吞咽困难的存在和特征，以及相关诊断测试（视频荧光透视吞咽研究（VFSS）、临床喂养评估（CFE）、胸部计算机断层扫描（CT）、肺支气管镜检查和上胃肠道/食管造影）的结果。
该队列的 50%存在 PD，88.6%存在喂养困难。在 118 次就诊中（87 次 VFSS 和 31 次 CFE），48 个月以上儿童最常出现提示食管吞咽困难的喂养困难，24 至 48 个月儿童最常出现提示发育性喂养问题的喂养困难。VFSS 中 59.8%存在异常发现，其中最常见的吞咽困难征象是吸入（34.5%）和咽部残留（26.4%）。异常 UGI/食管造影发现与 3 个月内就诊时喂养困难的风险增加无显著相关性（风险比，RR=1.33）。存在吞咽困难与某些异常 CT 发现的风险增加相关（RR=空气间隙 3.0 和支气管扩张 3.0）。
EA/TEF 患儿常存在喂养/吞咽困难，且喂养困难的类型因患者年龄而异。UGI/食管造影异常发现并未增加喂养投诉的风险；然而，存在吞咽困难增加了异常胸部 CT 的风险。
