Analysis of respiratory problems in CHARGE syndrome: a single center study

Sangmi Song; Mi-Ran Park; Jihyun Kim; Youn-Ah Choi; Jinyoung Song; June Huh; I Seok Kang; Man Ki Chung; Han-Sin Jeong; Young-Ik Son; Kangmo Ahn

doi:10.4168/aard.2014.2.1.70

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Song, Park, Kim, Choi, Song, Huh, Kang, Chung, Jeong, Son, and Ahn: Analysis of respiratory problems in CHARGE syndrome: a single center study

Original Article

Allergy, Asthma & Respiratory Disease 2014; 2(1): 70-74.

Published online: 31 March 2014

DOI: https://doi.org/10.4168/aard.2014.2.1.70

Analysis of respiratory problems in CHARGE syndrome: a single center study

Sangmi Song¹, Mi-Ran Park^1,², Jihyun Kim^1,², Youn-Ah Choi³, Jinyoung Song¹, June Huh¹, I Seok Kang¹, Man Ki Chung⁴, Han-Sin Jeong⁴, Young-Ik Son⁴, Kangmo Ahn^1,²

¹Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea.

³Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

⁴Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Kangmo Ahn. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3539, Fax: +82-2-3410-0043, kmaped@skku.edu

Received 23 July 2013 Revised 23 September 2013 Accepted 25 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

CHARGE syndrome consists of multiple malformation including coloboma, heart defect, choanal atresia, growth or developmental retardation, genital anomalies, and ear anomalies. The aim of this study was to evaluate the respiratory problems in children with CHARGE syndrome.

Methods

Out of 9 patients with CHARGE syndrome, medical records from 8 patients showing respiratory distress or respiratory failure were retrospectively reviewed. We investigated the causes of respiratory problems by physical examination, endoscopy, echocardiogram, computed tomography, rigid bronchoscopy, swallowing test, and 24-hour impedence monitoring.

Results

Five patients required endotracheal intubation soon after birth due to bilateral choanal atresia (n=2) and congenital heart diseases (n=3). Three patients were intubated within a month because of surgery for complex heart diseases (n=2) or recurrent apnea (n=1). Tracheostomy was performed in 3 patients who showed primary or secondary subglottic stenosis. Among 8 patients who had aspiration or respiratory distress after feeding, cricopharyngeal incoordination and gastroesophageal reflux disease were found in 7 and 2 children, respectively. One patient died of aspiration during oral feeding.

Conclusion

Patients with CHARGE syndrome manifest respiratory distress or failure due to various causes including congenital anomaly in the airway, cardiac anomaly, neurologic or gastrointestinal problems. Therefore, pediatricians should be alert to the respiratory symptoms and signs in CHARGE syndrome and take active intervention from the birth to improve their long-term prognosis.

Keywords: CHARGE syndrome, Feeding methods, Choanal atresia, Subglottic stenosis

Figures and Tables

Table 1

Clinical manifestation and anomalies in patients with CHARGE syndrome

PDA, patent ductus arteriosus; N/D, not done; TEF, tracheoesophageal fistula; ASD, atrial septal defect; PA, pulmonary atresia; C-AVSD, complete atrioventricular septal defect; DORV, double outlet right ventricle; CoA, coarctation of aorta.

Table 2

Respiratory problems in patients with CHARGE syndrome

LMS, laryngomicrosurgery; CT, computed tomography; CPI, cricopharyngeal incoordination; GER, gastroesophageal reflux; N/D, not done; PDA, patent ductus arteriosus; CHD, congenital heart disease.

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