Historically, patients with EA-TEF had little follow-up by specialists
once they recovered from the initial repair. However, longitudinal
studies in adult survivors of EA-TEF highlighted the high prevalence of
respiratory complications across the lifespan44,46.
Early detection and management of respiratory complications may prevent
irreversible structural lung disease and loss of lung
function11,16,18,152.
The RCWG strongly recommends systematic follow-up by multidisciplinary
teams that include pulmonologists, gastroenterologists,
otolaryngologists, pediatricians and thoracic surgeons, as well as
dieticians, physiotherapists, speech-language pathologists or
occupational therapists, and social workers2,19,20,107,124,153–155. Some centres have also
included diagnostic and interventional radiologists and an
intensivist156. Special emphasis is given to have
regular evaluation and follow-up by psychologists because of growing
concern about the long-term effect of EA-TEF on the quality of life of
the patients and their families 157–160.
This approach allows the timely identification of multisystem treatable
abnormalities, better care coordination and increase safety by reducing
the number of exposure to general anesthesia152. For
the family, it decreases the number of visits to the hospital and the
associated facility charges. This results into higher family
satisfaction, while it remains cost effective for the
hospitals106,161,162 .
The RCWG strongly agreed that patients with EA-TEF should receive all
recommended mandatory vaccinations as well as the annual influenza
vaccine. There was only moderate agreement on the need for RSV
prophylaxis possibly reflecting different policies that exist in each
country regarding this intervention.
How often the patients need to be evaluated by the entire team depends
on the special needs of the patients and the feasibility of assembling
such a large team in each institution158.
Acknowledging that such a team may not be feasible in smaller
institutions, let alone in clinics or doctors’ offices, the RCWG
developed a list of the essential elements for the follow-up of patients
with EA-TEF (Tables 1A, 1B & 2)