A newborn baby boy presented with choking episodes during feeding. He was diagnosed with Type 2 tracheo-esophageal fistula, where the esophagus ends in a blind pouch and a fistula connects the upper pouch to the trachea. Treatment includes stopping feeding, providing IV fluids, placing a nasogastric tube in the upper pouch to drain secretions, elevating the baby's head, and definitive repair surgery. The prognosis depends on any associated birth defects.

1. Scenario
A newborn baby boy born through SVD (spontaneous
vaginal delivery) 1 hour ago presented to emergency
department with history of severe chocking twice, when
his mother tried to feed him after birth. Now medical
officer is unable to pass NG tube.
 What is the diagnosis?
 What is the type of defect present?
 How will you treat the child?

2. Diagnosis:
Tracheo-esophageal Fistula.
Type Of Defect:
Type 2 (Esophageal
atresia with fistula from upper pouch.)
Treatment:
General:
 Admit the patient.
 Feeding is stopped Immediately and I.V fluids are given.

3.  Start antibiotics.
 NG tube in the proximal pouch should be placed for
continuous suction to drain secretions and prevent
aspiration.
 Head of the bead should be elevated to prevent reflux
of gastric contents through the distal fistula into the
lungs.
Specific:
 Definitive treatment is by operation.

5. Tracheo-Esophageal Fistula
 There is discontinuity of esophageal lumen with
communication with trachea.
 It is characterized by a blind esophageal pouch and a
fistulous connection between the proximal and distal
esophagus (or both) and the airway
 In about 85% of the affected infants, the fistula is
between the distal esophagus and the airway.

6.  There may be history of polyhydramnios as there is a
high level of GIT obstruction.
 It has an Association with VATER and VACTERAL
syndrome. (Vertebral, Anorectal, Cardiac, Tracheo-
esophageal, Renal, and Limb abnormalities).

8. TYPES
There are five types:
1) Upper blind esophageal pouch and lower pouch
communicating with trachea.
2) Esophageal atresia with fistula from upper pouch.
3) Both the pouches and esophagus communicating with
trachea.
4) Esophageal atresia with no tracheal communication.
5) No esophageal atresia but fistulous communication with
trachea present (H-type fistula).

10. Clinical Features
 Infant present in the first hours of life
 There are copious secretions (bubbly baby syndrome),
chocking, cyanosis, and respiratory distress.
 On chest, after careful placement of a nasogastric tube
to the point at which resistance is met, the tube will be
seen in blind pouch. If the tracheo-esophageal fistula
is present to the distal esophagus, gas will be present
in intestine in a case of esophageal atresia without
tracheo -esophageal fistula.

11. Bending of tube due to TEF

12. Treatment
 Feeding is stopped Immediately and I.V fluids are
given.
 NG tube in the proximal pouch should be placed for
continuous suction to drain secretions and prevent
aspiration.
 Head of the bead should be elevated to prevent reflux
of gastric contents through the distal fistula into the
lungs.

13.  Definitive treatment is by operation. It depends on the
distance between the segment of the esophagus.

15. Prognosis
 It depends on presence or absence of associated
abnormalities.

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