The Infant with Tracheoesophageal Fistula and Esophageal Atresia

Abstract

A baby girl was delivered by normal spontaneous vaginal delivery after 35 weeks of uncomplicated gestation. Apgar scores were 9 at 1 minute and 10 at 5 minutes. Birth weight was 2250 gm. Shortly after delivery, he baby had several episodes of cyanosis and bradycardia and a “barking” type of cough. Large amounts of secretion were noted about the mouth and nose.

An attempt to pass a nasogastric tube was unsuccessful; obstruction was met at approximately 10 cm from the nares. A chest x-ray revealed the tube coiled in the upper esophagus. Right upper lobe atelectasis and air in the stomach were seen.

Physical examination revealed some respiratory distress and a deformity of the right arm. Sinus tachycardia was 192/in and tachypnea 55 breaths/in; ECG was otherwise normal. Initial laboratory values were as follows: hematocrit 62%; WBC 7000/m³; glucose 85 mg/dl; PaO₂ 55 mmHg (FiO₂. 35); PaCO₂ 37 mmHg. Other values were within normal limits.

The patient was scheduled for surgical repair of the tracheoesophageal fistula and esophageal atresia.

Reviewed by Dr. Elizabeth Brodman, Associate Professor of Anesthesiology, Montefiore Medical Center, Bronx, New York.