1. Meaning and definition of tracheoesophageal fistula:

Tracheoesophageal fistula (TEF) is a congenital anomaly in which an abnormal connection forms between the trachea and esophagus. The upper segment of the esophagus develops from the retropharyngeal portion, while the lower segment originates from the pregastric region of the primitive gut. 

Around the fourth week of gestation, the laryngotracheal groove appears, followed by longitudinal furrows that separate the respiratory primordium from the esophagus. Any disruption in this process, such as altered cellular growth, results in TEF1.

2. Incidence of tracheoesophageal fistula:

TEF is approximately 1 in 4,000 live births. The most common type, occurring in over 80% of cases, presents with esophageal atresia where the upper esophagus ends blindly, and the lower esophagus communicates with the trachea through a fistula2.

3.Clinical Features:

Maternal polyhydramnios and the presence of a single umbilical artery may indicate esophageal atresia. 

TEF is often associated with congenital anomalies, including VACTERL (vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, renal anomalies, and limb defects) 1. 

Affected neonates exhibit excessive drooling, frothing, choking, and cyanosis upon feeding. Due to esophageal obstruction, milk and saliva overflow, leading to aspiration pneumonia when secretions pass through the fistulous tract into the lungs2.

4. Diagnosis of TEF:

TEF is suspected when a rigid red rubber catheter cannot pass into the stomach and halts at 7–10 cm from the mouth. A confirmatory X-ray may be taken after injecting 1–2 mL of air through the catheter. The use of contrast materials like barium is contraindicated due to the risk of aspiration2.

In the most common variant of TEF, X-ray imaging reveals an air bubble in the stomach due to the connection between the lower esophagus and the trachea. If no esophageal-tracheal communication exists, the stomach will appear gasless3.

5.Management of TEF:

 To minimize aspiration risk, Newborns with TEF should be positioned supine or upright. The esophageal pouch should be aspirated gently every five minutes or continuously using low-pressure suction. Supportive management includes intravenous fluids, prevention of aspiration pneumonia, and early surgical correction1. Definitive treatment involves surgical division of the fistula and primary esophageal anastomosis3 

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References

1. Ghai OP, Paul VK, Bagga A. Essential Pediatrics. 10th ed. New Delhi: CBS Publishers; 2023. p. 510-15.

2. Kliegman RM, St. Geme JW. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2023. p. 1837-42.

3. Wong DL, Hockenberry MJ, Wilson D. Wong’s Nursing Care of Infants and Children. 11th ed. St. Louis: Elsevier; 2022. p. 825-32.

Attempt the quiz session on TEF as per the NCLEX RN Exam and NORCET Exam.