TEF is an abnormal connection between the trachea and esophagus ,commonly found in LBW baby

1. DENCHIRA B MARAK
POST BASIC B.SC
NURSING 1st YEAR
ASIAN INSTITUTE OF
NURSING EDUCATION

2.  Among the obstructive anomalis of the
gastrointestinal tract in the new born
atresia of the esophagus rank second
[imperforate anus is first ] .Atresia of the
esophagus with tracheoesophageal
fistula occurs equally in both male and
female,with no evidence that genetic
factors are involve . Without early
diagnosis and corrective surgery this
condition is rapidly fatal.

3.  Tracheoesophageal fistula[TEF] is an
abnormal connection between trachea and
esophagus.This disorder are commonly
found among premature or low birth
weight [LBW] infant and mother having
polyhydramios.
 INCIDENCE:
Approximately 1of 3000to 4500 live birth
Equally occur in both male and female

4. TRACHEA :
4inches long
1inch in diameter
>support $ patency
>mucociliary escalation
>cough reflux
>filtering,warming

5. ESOPHAGUS:
25cm long and 2cm,D
>propel the food downward
>lower esophagus sphincter
moves food into the stomach

6.  Exact caused is unknown
 Often present with VACTERL
syndrome.
 Althered growth of septum between
trachea and esophagus
 Factor influencing the incedience of the
problem are heritable genetic
factor,teratogenic stimule and
intrauterine environment

7. Upper part of esophagus is developed from retropharyngeal
segment and the lower part of primitive gut.
At 4-5 weeks of gestation the laryngeal-tracheal groove is
formed
Two longitudinal furrows develop and separate the
respiratory tract permordium from esophagus
Deviation cellular growth of the septum results in formation
of fistula between esophagus and trachea

8.  TYPE -1:Esophageal atresia without
fistula
 Type-2: Esophageal atresia with tef
[upper]
 Type-3:Esophageal atresia with
tef[lower
 Type-4: Esophageal atresia with
TEF(both upper and lower)
 Type-5:H-type TEF

9.  3Cs of TEF;[ coughing,chocking and
cyanosis]
 Respiratory distress during feeding
 Seal bark cough
 Apnea
 Abdominal distension

10.  Simple technique with plain catheter
 Antenatal diagnosis by USG
 Postnatal diagnosis[usg,plain x-ray
abdomen and chest x-ray with radio
opaque catheter]

11. Bronchoscopy
ECG
Echocardiogram

12.  THERAPEAUTIC MANAGEMENT
 Propped up position[30 degree angle]
 Nill orally
Airway clearance
oxygen therapy
I.V. therapy
Nasogastric tube to be kept in situ
Gastrostomy
Supportive care

15. 1.Primary surgical correction
2.Staging surgery
3.Other surgical intervention
.cervical esophagostomy
.esophago- coloplasty
.esophago-gastroplasty

17.  NURSING ASSESSMENT:
1)Assess family history of the mother
2)Assess the mother antenatal check up
obtain the history of polyhydramnios
3)Assess the baby for acronym VACTERL
syndrome
4)Assess infants for wheather pre term or
LBW

18. 1)Ineffective breathing pattern related to
accumulation of saliva or feed
2)Imbalanced nutrition less than body
requirement related to disease process

19. 3)Fluid volume deficient related to unable
to take orally
4)Risk for infection related to surgical
procedure
5)Parentral anxiety releted to critical
situation of the infant

20.  Death from asphyxia
 Anastomotic leak
 Dysphagia
 Respiratory distress
 Gastro esophageal reflux
 Temperature instability

21.  The prognosis is related to the birth
weight associated congenital anomalies
and time of diagnosis.The survival rate
is nearly 100%in full term infant
without severe respiratory distress or
other anomalies.Inpre term LBW infant
with associated anomalies ,the
incidence of complication is high