Respiratory function and clinical outcome in children with repaired esophageal atresia (EA) and tracheoesophageal fistula (TEF)

Despite the refinement of surgical techniques, a considerable proportion of children with EA/TEF experiences long-term respiratory complications through adulthood. In this case-control study we evaluated the respiratory outcome of 13 children operated at birth for EA/TEF in a single pediatric surgery center. All the children underwent forced spirometry, skin prick test (SPT), residual volume (RV), diffusion capacity, global airways resistance and fraction of exhaled NO (FeNO) measurement. In a median 9-year follow-up (range 5-15 yr), cases reported a higher and more severe number of lower respiratory tract infections, compared to controls (12 vs 9). SPT were positive in 23% of cases and in 7% of controls. FeNO resulted similar in the two groups (11 ppb in cases and 12 in controls). EA patients had a mean Forced Vital Capacity of 73% (104% in controls) and a mean Forced Expiratory Volume 1 sec of 82% (95% in controls). No patient in the case group had an obstructive impairment. RV and diffusion capacity were normal (96% and 103% respectively), while the measurement of the resistances with the interruption technique has documented higher baseline values in cases (230%) than in controls (104%), mostly with no pharmacologic reversibility. In children with EA/TEF we documented the persistence of respiratory morbidity with spirometric restrictive pattern, suggestive of narrowed airways and poor lung growth.