Anti-reflux medications after esophageal atresia repair - it is used in your settings?

[Stefan Johansson]

We had the discussion recently about long-term use of anti-reflux medications after esophageal atresia repair.

Drugs like lansoprazol can really clogg the NG tube (like concrete!)... and from what I read in this systematic review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899117/) it seems that there is no clear benefit. Although the quality of evidence is classified as low, and that "more research is needed".

Do your pediatric surgeons advocate the use of anti-reflux medications after esophageal atresia repair? If yes, for how long?
If the infant needs NG tube feeding for a longer period time (like 4-8 weeks), how often do you change the NG tube?

Asking for a friend

 

[Hamed]

Over here, in Japan Famotidine (Gaster 10) for 2 weeks is almost a standard postoperative regimen after esophageal atresia advocated by Pediatric surgeons. However,  almost all the cases continue on it for a month or more.

[yangw126]

In my NICU, the nurses change the NG tube every  7 days.

[Stefan Johansson]

@yangw126 but do you change NG tube every week also if the infant is postop esofageal atresia?

We also change tube every week in preterm infants in general. But, postop esofageal atresia, our surgeons want us to leave the NG tube as long it is needed, i.e. take it out when the infant can feed orally

[yangw126]

We change NG tube every week in preterm infants in general

13 hours ago, Stefan Johansson said:

@yangw126 but do you change NG tube every week also if the infant is postop esofageal atresia?

We also change tube every week in preterm infants in general. But, postop esofageal atresia, our surgeons want us to leave the NG tube as long it is needed, i.e. take it out when the infant can feed orally

We  change  NG tube every week in preterm infants

[Hamed]

The OG tube in postoperative oesophageal atresia is placed by the pediatric surgeon and is kept as long as possible until oral feed. This is to avoid injury of the anastomosis site if the OG is replaced blindly.

[bimalc]

On 6/21/2018 at 12:02 AM, Hamed said:

Over here, in Japan Famotidine (Gaster 10) for 2 weeks is almost a standard postoperative regimen after esophageal atresia advocated by Pediatric surgeons. However,  almost all the cases continue on it for a month or more.

This has been roughly my experience in3 different surgical NICUs in US

[tarek]

I enjoyed the discussion although we know that the benifit is less or even no benifit still many are using H2 blocker or proton pump inhibitor even some are using metoclopramide

 

The first 5 days postop NGT or OGT is mandatory then gastrographin to be sure that there is no leak 

after that depend on GA and when we will start oral feeding