Clinical
Pediatric Eating Assessment Tool-10 as an indicator to predict aspiration in children with esophageal atresia

https://doi.org/10.1016/j.jpedsurg.2017.02.018Get rights and content

Abstract

Aim

Airway aspiration is a common problem in children with esophageal atresia (EA). Pediatric Eating Assessment Tool-10 (pEAT-10) is a self-administered questionnaire to evaluate dysphagia symptoms in children. A prospective study was performed to evaluate the validity of pEAT-10 to predict aspiration in children with EA.

Methods

Patients with EA were evaluated for age, sex, type of atresia, presence of associated anomalies, type of esophageal repair, time of definitive treatment, and the beginning of oral feeding. Penetration-aspiration score (PAS) was evaluated with videofluoroscopy (VFS) and parents were surveyed for pEAT-10, dysphagia score (DS) and functional oral intake scale (FOIS). PAS scores greater than 7 were considered as risk of aspiration. EAT-10 values greater than 3 were assessed as abnormal. Higher DS scores shows dysphagia whereas higher FOIS shows better feeding abilities.

Results

Forty patients were included. Children with PAS greater than 7 were assessed as PAS + group, and scores less than 7 were constituted as PAS − group. Demographic features and results of surgical treatments showed no difference between groups (p > 0.05). The median values of PAS, pEAT-10 and DS scores were significantly higher in PAS + group when compared to PAS- group (p < 0.05). The sensitivity and specificity of pEAT-10 to predict aspiration were 88% and 77%, and the positive and negative predictive values were 22% and 11%, respectively. Type-C cases had better pEAT-10 and FOIS scores with respect to type-A cases, and both scores were statistically more reliable in primary repair than delayed repair (p < 0.05). Among the postoperative complications, only leakage had impact on DS, pEAT-10, PAS and FOIS scores (p < 0.05).

Conclusions

The pEAT-10 is a valid, simple and reliable tool to predict aspiration in children. Patients with higher pEAT-10 scores should undergo detailed evaluation of deglutitive functions and assessment of risks of aspiration to improve safer feeding strategies.

Level of evidence

Level II (Development of diagnostic criteria in a consecutive series of patients and a universally applied “gold standard”).

Section snippets

Patients and methods

Patients operated for EA were evaluated for age, sex, weight (percentiles validated for Turkish children), type of atresia, presence of associated anomalies, type of esophageal repair, time to definitive treatment and the beginning of oral feeding. The study was carried out in collaboration with Department of Pediatric Surgery and Center for Swallowing Disorders of Hacettepe University. Patients who admitted to our center for the last year were included. Children younger than one- year of age,

Results

Forty patients were included in this study. Children with penetration-aspiration in VFS (PAS > 7) were assessed as the PAS + group (n = 9), and patients with PAS < 7 were included in the PAS- group (n = 31). Demographic features and results of surgical treatment showed no difference between PAS + and PAS- groups (p > 0.05) (Table 5). Fourteen patients had associated anomalies (33% of PAS + and 35% of PAS- patients). Ten patients had cardiac anomalies, three of them had genitourinary anomalies, and one

Discussion

In this study we found that pEAT-10 is validated and simple assessment tool to predict airway aspiration in children with EA. It is also useful to define which patients need further investigations for respiratory problems. Respiratory problems after EA repair are very common and constitute 44% of all hospital admission rates for children [10]. Respiratory complications are related with GERD, aspiration, tracheomalacia, recurrent TEF and esophageal strictures [11]. Aspiration of airways is

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