Dayton Children’s Hospital

Esophageal Atresia and Tracheoesophageal Fistula

What are Esophageal Atresia and Tracheoesophageal Fistula?

Esophageal Atresia (EA) is a condition in which the tube that carries food from the mouth to the stomach (esophagus) does not develop properly. In babies with EA, the upper esophagus does not connect with the lower esophagus and stomach, creating a gap between the two ends. This can prevent your baby from swallowing properly, which interferes with normal feeding. It can also lead to breathing problems.

In approximately 85 percent of babies with EA, there is also a connection between the breathing tube (trachea) and the esophagus, a condition that is known as tracheoesophageal fistula (TEF). In EA with TEF, the upper pouch of the esophagus ends blindly and the lower end connects with the trachea.

The exact cause of EA with TEF is unknown. It is a congenital defect, which means it is present at birth. About 30 to 40 percent of babies diagnosed with EA with TEF will also have other system abnormalities.

How are Esophageal Atresia and Tracheoesophageal Fistula diagnosed?

EA is sometimes discovered during pregnancy during a routine prenatal ultrasound, although it is difficult to make a definitive diagnosis until after the baby is born. An excessive amount of amniotic fluid (polyhydramnios) seen on ultrasound may be an indication of EA. In most cases, EA with TEF is not diagnosed until the baby begins to show symptoms after birth. Common symptoms of EA with TEF include:

  • Skin turning blue (cyanosis) while feeding
  • Coughing, gagging and choking while feeding
  • Excessive drooling

If your baby is showing symptoms of EA with TEF, tests may be done to confirm the diagnosis. Tests may include:

  • Inserting a feeding tube through the nose to see if it will reach the stomach
  • Chest X-ray

How are Esophageal Atresia and Tracheoesophageal Fistula treated?

On occasion, when ET and TEF are suspected prior to delivery and accompanied by an excessive amount of amniotic fluid (polyhydramnios), the mother may experience preterm labor and/or difficulty breathing. This is due to the often massive distension of her uterus from the excess amniotic fluid. An amnioreduction procedure can be performed to relieve the symptoms for the mother, but this is only temporary and does not treat the underlying cause of the polyhydramnios.

 

EA and TEF are treated with surgery to repair the defect(s). In some cases, more than one surgery will be required. The severity of your baby’s defect will determine the type of surgical treatment needed. Your baby’s neonatologist and pediatric surgeon will carefully explain each step of the surgical process.

How will Esophageal Atresia and Tracheoesophageal Fistula affect my baby during and after surgery?

During the surgery, your baby will be given general anesthesia, which means the baby will be sleeping. After surgery, your baby will need to stay in the hospital’s neonatal intensive care unit (NICU) for the first few days and may be connected to several tubes and wires. Most of the tubes and wires will be disconnected before your baby leaves the NICU. However, your baby may need to stay in the hospital for several more weeks.

 

Your baby will be given IV fluids as a means of nutrition for the first several days after surgery. Feeding will be initiated after studies have established that the surgery was successful. Establishing full feedings may take several days to weeks.