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      Efficacy of a standardized tube weaning program in pediatric patients with feeding difficulties after successful repair of their esophageal atresia/tracheoesophageal fistula

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          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.

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          Most cited references16

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          Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition.

          Walter Mihatsch, John Puntis, Sibylle Koletzko … (2010)
          Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.
          Article 0 comments Cited 36 times – based on 0 reviews     Review now
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            Thoracoscopic traction technique in long gap esophageal atresia: entering a new era

            David Van der Zee, Gabriele Gallo, Stefaan H. A. Tytgat (2015)
            Objective To describe the evolution from delayed management of long gap esophageal atresia to thoracoscopic treatment directly after birth without the placement of a gastrostomy. Background Long gap esophageal atresia remains a challenge for pediatric surgeons. Over the years, several techniques have been described to deal with the problem of the distance between the proximal and distal esophagus. More recently, a traction technique has been advocated. With the advent of minimal invasive surgery, the thoracoscopic elongation technique has been developed. Methods Retrospective description of a single-center experience with the thoracoscopic treatment of patients with long gap esophageal atresia over a 7-year period. Results Between 2007 and May 2014, 10 children with long gap esophageal atresia were treated by thoracoscopic elongation technique. In two children, the procedure failed. Eight children successfully underwent thoracoscopic traction with delayed primary anastomosis. Initially, all patients had a gastrostomy. During the course, the technique evolved into delayed primary anastomosis directly after birth without the use of a gastrostomy. Conclusion Thoracoscopic elongation technique in long gap esophageal atresia not only is feasible, but can nowadays also be performed directly after birth without the use of a gastrostomy. With this development, we have entered a new era in the management of long gap esophageal atresia.
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              Nutritional and psychosocial outcomes of gastrostomy tube-dependent children completing an intensive inpatient behavioral treatment program.

              Alan Silverman, Richard J Noel, Colin D Rudolph … (2013)
              Limited published data describe the long-term effects of behavioral strategies to wean children from gastrostomy tube (GT) feeding dependence. This study presents data relating to nutritional and psychosocial outcomes observed during a 1-year period in medically complex GT feeding-dependent patients who completed an inpatient behavioral-based tube weaning protocol.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sabine Marinschek:
                ORCID: http://orcid.org/0000-0002-2845-0084
                sabine.marinschek@medunigraz.at
                Karoline Pahsini: karoline.pahsini@medunigraz.at
                Victor Aguiriano-Moser: victor.aguiriano-moser@medunigraz.at
                Marion Russell: mru97753@creighton.edu
                Barbara Plecko: barbara.plecko@medunigraz.at
                Eva Z. Reininghaus: eva.reininghaus@medunigraz.at
                Holger Till: holger.till@medunigraz.at
                Marguerite Dunitz-Scheer: marguerite.dunitz-scheer@medunigraz.at
                Journal
                Journal ID (nlm-ta): Eur J Pediatr
                Journal ID (iso-abbrev): Eur J Pediatr
                Title: European Journal of Pediatrics
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0340-6199
                ISSN (Electronic): 1432-1076
                Publication date (Electronic): 15 May 2020
                Publication date PMC-release: 15 May 2020
                Publication date (Print): 2020
                Volume: 179
                Issue: 11
                Pages: 1729-1737
                Affiliations
                [1 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Department of Psychiatry and Psychotherapeutic Medicine, , Medical University of Graz, ; Auenbruggerplatz 31, 8010 Graz, Austria
                [2 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Department of Paediatrics and Adolescent Medicine, Division of General Pediatrics, , Medical University of Graz, ; Auenbruggerplatz 34/2, 8010 Graz, Austria
                [3 ]GRID grid.254748.8, ISNI 0000 0004 1936 8876, School of Pharmacy and Health Professions, , Creighton University, ; 2412 Cuming sT #201, Omaha, NE 68131 USA
                [4 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Department of Paediatric and Adolescent Surgery, , Medical University of Graz, ; Auenbruggerplatz 34, 8010 Graz, Austria
                Author notes

                Communicated by Peter de Winter

                Author information
                http://orcid.org/0000-0002-2845-0084
                Article
                Publisher ID: 3673
                DOI: 10.1007/s00431-020-03673-w
                PMC ID: 7547996
                PubMed ID: 32415337
                SO-VID: fd14dd4b-dad8-4690-ac15-0eba833dac2b
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 21 February 2020
                Date revision received : 22 April 2020
                Date accepted : 29 April 2020
                Funding
                Funded by: Medical University of Graz
                Open Access :

                Open access funding provided by Medical University of Graz.

                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                ScienceOpen disciplines: Pediatrics
                Keywords: esophageal atresia,tracheoesophageal fistula,enteral nutrition,tube weaning,online coaching
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: esophageal atresia, tracheoesophageal fistula, enteral nutrition, tube weaning, online coaching

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