A 3-day-old baby was admitted to the hospital with difficulty feeding, cyanosis during feeding, and not passing stool since birth. On examination, the baby had crepitations in both lungs on auscultation and was lethargic. An inability to pass a nasogastric tube and profuse oral secretions suggested a provisional diagnosis of tracheoesophageal fistula.

1. CASE PRESENTATION
TRACHEOESOPHAGEAL FISTULA
PRESENTER: DR. SOURAV MONDAL

2. PATIENT DETAILS
Name: B/O Mrs. Shakuntala Kewat
Age: 3 days, delivered by LSCS on 30/10/2018
Sex: Male
Weight: 1.8 kg
DOA: 30/10/18
DOE:02/11/18
Residence : Rewa

3. CHIEF COMPLAINTS :-
As per the mother, her baby
 Has difficulty in feeding since birth
 Turns blue after feeding since birth
 Excessive frothing from the mouth, more so
after feeding, reappeared on wiping
 Has not passed stool since birth.

4. HISTORY OF PRESENTING ILLNESS:
According to the mother, her baby has difficulty in
feeding and exhibits signs of cyanosis and choking
during oral feeding, since birth.
The baby also had profuse oral secretions and
regurgitation of the contents after feeding.
Paediatrician found it difficult to pass nasogastric
tube at birth.

5. BIRTH HISTORY
Born at 37 weeks gestation via lower segment
caesarean section to a 32 years G1P1 mother on
30/10/2018 at 9.50pm ,whose 1st antenatal visit
was in the 3rd trimester when she received inj TT
but was diagnosed to have polyhydraminos.
APGAR score was unknown but the mother said
that the baby cried immediately after birth.

6. PAST HISTORY:
No h/o of medical, surgical illness till date.
IMMUNIZATION HISTORY:
Received OPV and BCG vaccines at birth .

7. H/O DRUG ALLERGY:-
No medications were given.
PERSONAL HISTORY:-
Did not pass stool since birth
Passed urine thrice since morning, on the day of
examination.
FAMILY HISTORY:-
No h/o similar complaints or any other chronic
illness in the family

8. GENERAL PHYSICAL EXAMINATION
Temp – 98.6 ˚F (per rectal)
HR – 156 per min
RR – 45 per min
BP – 60/35 mm of Hg
Colour - pink
SpO2 – 95% on Oxygen

9. Weight – 1.8 kg
Length – 47 cm
Head circumference – 34 cm
Chest circumference – 31cm
Polydactyly - absent
No signs of pallor, icterus, cyanosis
present

10. RESPIRATORY SYSTEM:-
Inspection : B/L chest movements equal
Palpation :
 Trachea central
 B/L equal chest expansion
Auscultation : B/L crepitations present

11. CARDIOVASCULAR SYSTEM:-
Inspection: No deformity, no engorged superficial
veins , no visible pulsations
Palpation: Apex beat felt in 4th ICS medial to left mid
clavicular line
Auscultation:- S1 S2 present with no added sounds
CENTRAL NERVOUS SYSTEM :-
Lethargic, drowsy

12. GASTROINTESTINAL SYSTEM
Inspection – Profuse oral secretions requiring
frequent suctioning. Scaphoid abdomen. No
superficial veins, no visible pulsations seen. Normal
cord stump, no active discharges present.
Auscultation – Bowel sounds present.
Inability to pass nasogastric tube.
Did not pass stool since birth.

13. LABORATORY VALUES
 Hb – 15.5 gm/dl
 Plt- 2.5 lakh/cu.mm
 TLC – 11500 / cu.mm
 Diff count – N52L40E0M2

14. SUMMARY
 A 3 day old baby delivered by LSCS to a 32 years old
G1P1 mother with history of polyhydraminos was
admitted in SNCU with the complaints of difficulty in
oral feeding and episodes of cyanosis and choking
during and after feeding, since birth.
 His mother also complained of profuse oral
secretions and regurgitation of the contents after
feeding.

15.  Auscultation revealed B/L chest crepitations.
 CNS examination revealed lethargic and drowsy
condition.
 Gastrointestinal examination revealed
 Inability to pass nasogastric tube.
 No passage of stool since birth

16. PROVISIONAL DIAGNOSIS
My provisional diagnosis is that the
baby is suffering from
TRACHEOESOPHAGEAL FISTULA.

17. THANK YOU