It is the failure of the esophagus to form a continuous passage
from pharynx to stomach during embryonic development resulting in
obstruction in infants normal swallowing routes.
TRACHEO ESOPHAGEAL FISTULA
It is the Abnormal connection between trachea and esophagus
or failure of esophagus to separate into two distinct structure .
Approximately in infants of 3,000-3,500 live births.
Occur Both males and famales, frequently associated
Occur one in 4,000 babies in the united states is born
with esophageal atresia.
It is the 25th most common birth defect.
Chromosomal anomalies (trisomy 18, trisomy 21, and
Failure of embryonic development
Digestive tract problems(diaphragmatic hernia,
intestinal atresia or imperforated anus.)
Congenital heart diseases(ventricular septal
defect,tetralogy of fallot or patent ductus arteriosus.)
Renal and urinary tract problems(horseshoe or
polycystic kidney,absent kidney or hypospadias)
TYPE A "LONG GAP", “PURE” OR “ISOLATED” ESOPHAGEAL ATRESIA
TYPE B ESOPH AGEAL ATRESIA WITH PROXIMAL TEF
TYPE C ESOPHAGEAL ATRESIA WITH DISTAL TEF (TRACHEOESOPHAGEAL
TYPE D ESOPHAGEAL ATRESIA WITH BOTH PROXIMAL AND DISTAL TEFS
(TWO TRACHEOESOPHAGEAL FISTULAS)
TYPE E TEF (TRACHEOESOPHAGEAL FISTULA) ONLY WITH NO
TYPE F ESOPHAGEAL STENOSIS
developed from first segment of embryonic
gut.During the 4th and 5th week of gestation ,forgut normally
lengthens and separate longitudinally and longitudinal portion fuse
to form parallel channels. Anomalies involving trachea and
esophagus are caused by defective incomplete fusion of the
tracheal folds following separation or altered cellular growth
during embryonic development.
Excessive Salivation & Drooling
Frothy white bubbles in baby’s mouth
3C’S of TEF
Chocking (when the baby is feeding)
Coughing (when the baby is feeding)
Cyanosis (when the baby is feeding)
Abdominal Distension( very round full abdomen)
PLAIN X-RAY WITH CONTRAST IN THE UPPER
ESOPHAGUS SHOWING ATRESIA
Aspiration of stomach content.
• Molecular genetic testing
• Chromosome analysis
EA/TEF may be suspected Prenatally by:• Ultrasound examination
• Fetal MRI
EA may be detected Postnatally by:
•Failure to pass a nasogastric (NG) tube and
radiographs that demonstrate coiling of the NG tube
•Tracheal compression and deviation on plain chest
•Absence of a gastric bubble on plain radiographs,
which may suggest EA without a TEF or EA with a
• Three-dimensional CT scanning.
Treatment include: Maintanance of patient airway.
Prevention of pneumonia.
Gastric pouch decompression.
Surgical repair of anomalies.
Stop oral intake, start IV fluids.
Complication Of Surgery
Reaction to medicines.
Food leakage from the area that is repair.
Low body temperature(hypothermia).
Narrowing of the repaired organ.
Re-opening of the fistula.
Establishment of patient airway.
Prevention of further respiratory compromise.
Immediate after birth,nurse give the first feeding of plain water
and assist mother while feeding baby to observe any anomalies.
If cyanosis is present it can be resolved by removing secretions
from oropharynx by suctioning and by oxygen administration.
Stop oral fluids and start IV fluids.
Neonate is kept warm using an incubator or radient warmer.
Daily change of cathether (Indwelling double lumen cathether)
to prevent infection.
Provide supine position with 30 degree elevation and
of head to prevent aspiration ,If there is an atresia but
no fistula,infant is placed in head down position to
In staged repair gastrotomy tube inserted and left
open so that any air entering the stomach through
fistula can escape and prevent regurgitation.
POST OPERATIVE CARE
Elevate gastrotomy tube above the level of stomach so
that gravity helps an emptying of tube contents easily.
Infant is returned to radiant warmer.
Gastrotomy tube is connected to gravity drainage untill
infant can tolerate feeding.
Before oral feedings are initiated chest tubes are removed.
Assist initial attempts of oral feedings .
Antibiotics are administered.
PRE OPERATIVE NURSING DIAGNOSIS
Risk for suffocation related abnormal opening
between esophagus and trachea.
Risk for altered parenting related infants physical
defect and environmental factors causing parent
Fluid volume deficit related to inability to take oral
POST OPERATIVE NURSING DIAGNOSIS
Ineffective airway clearance
Altered nutritional status
Altered comfort pain