Tracheoesophageal fistula (A connection between trachea and oesophagus) is a surgical emergency of new born babies. It is usually diagnosed when baby become cyanosed (baby becomes blue) while trying to feed after birth. With improving antenatal diagnostic techniques it is more commonly diagnosed by antenatal ultrasound scans. Once diagnosed it has to be corrected in order to start feeding the child and to prevent aspiration of secretions.
Once diagnosis is made or when an antenatally diagnosed baby with Tracheoesophageal fistula is born, they should be kept nil by mouth (With out feeds). Then NG tube is passed to see if it makes its way to the stomach. Unless there is a H type tracheoesophageal fistula (as shown in the above picture), NG tube will not pass in to the stomach.
Then the chest x-ray will show the coiling up of NG tube with in the esophagus. You will see absence of stomach air and distal air shadows if there is total discontinuity in the oesophagus in case of pure esophageal atresia.
Once the baby is stable, he/she should be transferred to a surgical unit for corrective surgery. A baby with this condition may require ICU care with ventilator support if unstable prior to surgery. Tracheoesophageal fistula repair is ideally carried out as soon as possible in order to allow feeding and to prevent aspiration. Once in a specialized surgical unit baby will undergo further investigations such Ultrasound scans and upper GI contrast studies for definitive diagnosis.
Posted in: Emergency,Paediatrics,Surgery
