Pediatric Surgery Congenital Anomalies Prospective Follow-up Clinic: Gastroschisis, Omphalocele, Esophageal Atresia and Tracheoesophageal Fistula

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Date
2017
Authors
Dick, Andrew
Lum Min, Suyin
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Abstract
Infants born with gastroschisis, omphalocele, tracheoesophageal fistula or esophageal atresia are increasingly likely to survive beyond the Neonatal Intensive Care Unit due to improved supportive care. After the acute management and surgical interventions have been completed, these patients are variably followed by their pediatric surgeons. Therefore, a review of the existing literature to create disease-specific guidelines for the long-term follow-up of patients was deemed necessary to improve and standardize care. The guidelines will be tailored to the resources and expertise available at Winnipeg Children’s Hospital at Health Sciences Centre. This report will also outline the role of a PA in a Pediatric Surgery follow-up clinic and describe how PA involvement can enhance the accessibility and quality of care provided. Methods: The PRISMA reporting guideline for systematic reviews was used to select papers that met the criteria for this literature review. Publications within the last 15 years were chosen and deemed eligible by searching for each congenital anomaly with the terms “follow-up” and/or “outcomes” and/or “long-term” and/or “quality of life”. Results: The literature review identified long-term sequelae for survivors of each congenital anomaly. Neurodevelopmental delay, gastrointestinal symptoms and disease, poor growth, malnutrition and cosmetic concerns were common sequelae noted to potentially impact the quality of life of survivors. Conclusion: These individuals are likely to face a variety of health and developmental challenges in life. Establishing a clinic that applies these proposed guidelines will help ensure that each child has the best chance to access needed investigations and treatments in a timely manner, while maintaining a quality of life comparable to that of the general population. Physician Assistants should be viewed as essential to the success of this clinic. Their competency and skill set can meet the broad demands of the clinic while freeing physicians to focus on less-routine, more complex tasks related to the clinic or elsewhere.
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Keywords
Gastroschisis, Omphalocele, Tracheoesophageal fistula, Esophageal atresia, Long-term, Follow-up, Physician Assistant
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