Eur J Pediatr Surg 2021; 31(01): 069-075
DOI: 10.1055/s-0040-1716880
Original Article

Parent-Reported Feeding Difficulties among Children Born with Esophageal Atresia: Prevalence and Early Risk Factors

Sofie Örnö Ax
1   Department of Pediatric Surgery, Queen Silvia Children's and Youth Hospital, Goteborg, Västra Götalandsregionen, Sweden
,
Kate Abrahamsson
2   Department of Pediatric Surgery, Queen Silvia Children's and Youth Hospital, Goteborg, Sweden
,
Vladimir Gatzinsky
2   Department of Pediatric Surgery, Queen Silvia Children's and Youth Hospital, Goteborg, Sweden
,
Linus Jönsson
2   Department of Pediatric Surgery, Queen Silvia Children's and Youth Hospital, Goteborg, Sweden
,
Michaela Dellenmark-Blom
3   Department of Pediatrics, University of Gothenburg Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Goteborg, Sweden
› Author Affiliations
Funding The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (grant sponsor: ALF; grant number: ALFGBG-717911), and by the Queen Silvia Jubilee Foundation, 2019.

Abstract

Introduction We aimed to describe the prevalence of observable feeding difficulties during mealtimes among children with repaired esophageal atresia (EA) and to determine their early predictors.

Materials and Methods A survey, based on parents' reports and concerning difficulties in EA children's nutritional intake, was performed with the help of 114 families of 2 to 17-year-old EA patients. Neonatal and clinical/surgical data were collected from medical records. Comparisons were made of the prevalence n (%) of feeding difficulties between children in three age groups (2 to 7 years, 8 to 12 years, or 13 to 17 years of age) using the Mantel-Haenszel chi-square test. Logistic regression identified outcome predictors (odds ratio: 95% confidence interval). Predictors with p ≤ 0.1 in the univariable analysis were included in multiple regression analysis (p < 0.05).

Results Seventy-five percent of the young children aged 2 to 7, (median number of feeding difficulties: 2), 61% of school-aged children aged 8 to 12 (median number of feeding difficulties: 1), and 60% patients in the teenage group, aged 13 to 17, (median number of feeding difficulties: 1), reported feeding difficulties. Surgical complications after EA repair independently predicted children having a gastrostomy (p ≤ 0.01), using a food infusion pump (p ≤ 0.01), taking small portions to facilitate eating (p = 0.01), and needing >30 minutes to finish a main meal (p = 0.02). Congenital independent predictors were VACTERL, low birth weight, and preterm birth.

Conclusion Parentally observed feeding difficulties were commonly reported during early childhood, although prevalence decreases in older age groups. Several congenital and surgical factors were identified as independent predictors of complicated nutritional intake patterns.

Supplementary Material



Publication History

Received: 01 May 2020

Accepted: 16 August 2020

Article published online:
07 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pedersen RN, Calzolari E, Husby S, Garne E. EUROCAT Working group. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child 2012; 97 (03) 227-232
  • 2 Shah R, Varjavandi V, Krishnan U. Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula. Dis Esophagus 2015; 28 (03) 216-223
  • 3 Pedersen RN, Markøw S, Kruse-Andersen S. et al. Esophageal atresia: gastroesophageal functional follow-up in 5-15 year old children. J Pediatr Surg 2013; 48 (12) 2487-2495
  • 4 Acher CW, Ostlie DJ, Leys CM, Struckmeyer S, Parker M, Nichol PF. Long-term outcomes of patients with tracheoesophageal fistula/esophageal atresia: survey results from tracheoesophageal fistula/esophageal atresia online communities. Eur J Pediatr Surg 2016; 26 (06) 476-480
  • 5 Olbers J, Gatzinsky V, Jonsson L. et al. Physiological studies at 7 years of age in children born with esophageal atresia. Eur J Pediatr Surg Z Kinderchir 2015; 25 (05) 397-404
  • 6 Nurminen P, Koivusalo A, Hukkinen M, Pakarinen M. Pneumonia after repair of esophageal atresia: incidence and main risk factors. Eur J Pediatr Surg 2019; 29 (06) 504-509
  • 7 Mousa H, Krishnan U, Hassan M. et al. How to care for patients with EA-TEF: the known and the unknown. Curr Gastroenterol Rep 2017; 19 (12) 65
  • 8 Castilloux J, Noble AJ, Faure C. Risk factors for short- and long-term morbidity in children with esophageal atresia. J Pediatr 2010; 156 (05) 755-760
  • 9 Dellenmark-Blom M, Dingemann J, Witt S. et al. The esophageal-atresia-quality-of-life questionnaires: feasibility, validity and reliability in Sweden and Germany. J Pediatr Gastroenterol Nutr 2018; 67 (04) 469-477
  • 10 Chetcuti P, Phelan PD. Gastrointestinal morbidity and growth after repair of oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child 1993; 68 (02) 163-166
  • 11 Puntis JW, Ritson DG, Holden CE, Buick RG. Growth and feeding problems after repair of oesophageal atresia. Arch Dis Child 1990; 65 (01) 84-88
  • 12 Menzies J, Hughes J, Leach S, Belessis Y, Krishnan U. Prevalence of malnutrition and feeding difficulties in children with esophageal atresia. J Pediatr Gastroenterol Nutr 2017; 64 (04) e100-e105
  • 13 Svoboda E, Fruithof J, Widenmann-Grolig A. et al. A patient led, international study of long term outcomes of esophageal atresia: EAT 1. J Pediatr Surg 2018; 53 (04) 610-615
  • 14 Schier F, Korn S, Michel E. Experiences of a parent support group with the long-term consequences of esophageal atresia. J Pediatr Surg 2001; 36 (04) 605-610
  • 15 Gottrand M, Michaud L, Sfeir R, Gottrand F. Motility, digestive and nutritional problems in esophageal atresia. Paediatr Respir Rev 2016; 19: 28-33
  • 16 Dellenmark-Blom M, Chaplin JE, Jönsson L, Gatzinsky V, Quitmann JH, Abrahamsson K. Coping strategies used by children and adolescents born with esophageal atresia—a focus group study obtaining the child and parent perspective. Child Care Health Dev 2016; 42 (05) 759-767
  • 17 Dellenmark-Blom M, Chaplin JE, Gatzinsky V. et al. Health-related quality of life experiences among children and adolescents born with esophageal atresia: development of a condition-specific questionnaire for pediatric patients. J Pediatr Surg 2016; 51 (04) 563-569
  • 18 Bevilacqua F, Ragni B, Conforti A. et al. Fixed the gap, solved the problem? Eating skills in esophageal atresia patients at 3 years. Dis Esophagus 2020; 33 (01) doz102
  • 19 Dellenmark-Blom M, Chaplin JE, Quitmann JH. et al. The prevalence and role of coping strategies in the nutritional intake of children born with esophageal atresia: a condition-specific approach. Dis Esophagus 2019; 32 (07) doz004
  • 20 Gibreel W, Zendejas B, Antiel RM, Fasen G, Moir CR, Zarroug AE. Swallowing dysfunction and quality of life in adults with surgically corrected esophageal atresia/tracheoesophageal fistula as infants: forty years of follow-up. Ann Surg 2017; 266 (02) 305-310
  • 21 The Federation of Esophageal Atresia and Tracheo-Esophageal Fistula Support Groups Homepage. Long-term esophageal complications. Accessed March 6, 2020 at: https://www.we-are-eat.org/tell-me-about-esophageal-atresia/long-term-esophageal-complications/
  • 22 Dellenmark-Blom M, Quitmann J, Dingemann J. et al. Clinical factors affecting condition-specific quality-of-life domains in pediatric patients after repair of esophageal atresia: the Swedish-German EA-QOL Study. Eur J Pediatr Surg 2020; 30 (01) 96-103
  • 23 Vergouwe FWT, Vlot J, IJsselstijn H. et al. DCEA Study Group. Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study. Arch Dis Child 2019; 104 (02) 152-157
  • 24 Parolini F, Leva E, Morandi A. et al. Anastomotic strictures and endoscopic dilatations following esophageal atresia repair. Pediatr Surg Int 2013; 29 (06) 601-605
  • 25 Serhal L, Gottrand F, Sfeir R. et al. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J Pediatr Surg 2010; 45 (07) 1459-1462
  • 26 Presse N, Taillefer J, Maynard S, Bouin M. Insufficient body weight of adults born with esophageal atresia. J Pediatr Gastroenterol Nutr 2016; 62 (03) 469-473
  • 27 Zimmer J, Eaton S, Murchison LE, De Coppi P, Ure BM, Dingemann C. State of play: eight decades of surgery for esophageal atresia. Eur J Pediatr Surg 2019; 29 (01) 39-48
  • 28 Thornton FJ, Barbul A. Healing in the gastrointestinal tract. Surg Clin North Am 1997; 77 (03) 549-573
  • 29 Solomon BD. VACTERL/VATER association. Orphanet J Rare Dis 2011; 6: 56-56
  • 30 Kassa AM, Dahl M, Strinnholm M, Engstrand Lilja H. Attention difficulties and physical dysfunction common in children with complex congenital malformations: a study of preschool children with VACTERL association. Acta Paediatr 2020; 109 (04) 783-789
  • 31 Najman JM, Williams GM, Nikles J. et al. Bias influencing maternal reports of child behaviour and emotional state. Soc Psychiatry Psychiatr Epidemiol 2001; 36 (04) 186-194
  • 32 Baird R, Levesque D, Birnbaum R, Ramsay M. A pilot investigation of feeding problems in children with esophageal atresia. Dis Esophagus 2015; 28 (03) 224-228