Case #08 Discussion:

The staff attempted to place an NG tube, but they were unable to advance the tube more than a few centimeters.

DIAGNOSIS: Given that the patient cannot tolerate feeds and an NG tube cannot be inserted, he appears to have esophageal atresia. If he had pure esophageal atresia, we would not expect to find any gas in the bowel, so there must be another source for air to reach the stomach. Thus this patient likely has a tracheoesophageal fistula.

ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA

• Esophageal atresia has an incidence 1 in 3,000 to 4,500 live births, 1 /3 of cases in premature infants, 85% have accompanying T-E fistula
• Caused by disorders in the formation and movement of paired cranial and single caudal folds in the embryonic foregut
• Clinical Manifestations:
  • Maternal polyhydramnios
  • Failure to pass NG tube
  • Infant with excessive drooling
  • Choking, cyanosis, coughing with attempt at feeding
  • H type fistulas may present with recurrent aspiration pneumonias
• Three types:
  • (1) atresia without accompanying fistula (9%)
  • (2) atresia with fistula - to proximal or distal esophagus (most common)
  • (3) fistula without atresia (H type)
• 50% of patients have associated anomalies
  • VACTER Association
    • Vertebral body segmentation defects
    • Anal atresia
    • Cardiovascular: patent ductus arteriosus, VSD
    • TE fistula
    • Radial ray hypoplasia, unilateral renal agenesis
    • Limb abnormalities