What Is Esophageal Atresia?
Esophageal atresia (EA) is a condition in which a baby’s food tube (esophagus) and stomach don’t connect because the tube didn’t form all the way before birth. This makes it impossible for your baby to eat by mouth, since there’s no way for food or liquid to travel to the stomach. Instead, those things spill into the windpipe (trachea) and get into the lungs. EA is sometimes diagnosed before birth but most commonly right after birth.
What Is Tracheoesophageal Fistula?
Tracheoesophageal fistula (TEF) is commonly associated with EA. It is a condition in which a baby’s windpipe and food tube are connected. This can cause food, liquid, and saliva to get into the windpipe and the lungs. TEF makes it hard for babies to breathe and can cause pneumonia. TEF is usually diagnosed right after birth.
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Esophageal Atresia and Tracheoesophageal Fistula Symptoms
Some symptoms of esophageal atresia and tracheoesophageal fistula include:
- breathing problems,
- lots of drooling,
- foamy mucus in the mouth or nose,
- unable to take feeds, and
- coughing or choking when trying to swallow, especially after a feeding.
Surgery for EA & TEF
Surgery is the only way to correct EA and TEF. Your baby will be admitted to the newborn intensive care unit (NICU). While in NICU, medical staff will X-ray your baby’s chest and insert a tube into your baby’s mouth to suck out saliva. Your baby will also be placed on his or her stomach to help with drainage. An IV will give fluids to your baby since he or she won’t be able to eat.
The majority of babies have a combination of EA and TEF. If your baby needs surgery for both TEF and EA, the surgery team will make an incision in the chest and begin with the TEF repair. If your baby is big enough, the team will complete the EA procedure during this surgery as well. If he or she is too small, the EA surgery will be put on hold and your baby will get a feeding tube until he or she is ready for the next surgery.
Occasionally, babies will have an isolated EA or TEF. If your baby has EA, the surgery team will make a connection between the food tube and the stomach through an incision in your baby’s chest. If your baby is too small, EA surgery might be put on hold and a feeding tube (also called a gastrostomy tube or g-tube) will be put into your baby’s belly until surgery.
If your baby only has TEF, the surgery team will close the connection between the windpipe and the food tube through an incision in your baby’s neck.
Several tubes may be used to help your baby recover after surgery. A chest tube helps drain fluid from the surgery site. A tube in your baby’s nose may connect to the stomach to release fluids and air while your baby recovers. A final tube will connect from your baby’s mouth to a breathing machine. We do not always use these tubes but sometimes they are helpful in recovery. If the tubes are put in place, it is very important that they are not dislodged in any way.
Your baby’s medical team will perform a swallow study five days after surgery. If your baby’s doctor decides the surgical site is healing well, we will start removing the tubes and feeding your baby 5–7 days after surgery.
Complications After Esophageal Atresia & Tracheoesophageal Fistula Repair
Sometimes the repaired food tube leaks outside of the surgery site, which just means your baby will need to spend some more time in the hospital with the chest tube in to heal. Occasionally babies will need repeat surgery.
If your baby is having a hard time swallowing, the food tube is too tight. The surgery team will need to open the area to stretch it, using a procedure called esophageal dilation. Some children will need repeated procedures.
Some babies have tracheomalacia. This is the narrowing or collapse of the airway that can make it hard to breathe. Occasionally babies need surgery for this.
Some babies get gastroesophageal reflux (GER) after surgery, which means some of the food and liquids in the stomach are pushed back up into the food tube. Medical staff will give your baby medicine to keep this from happening and will tell you how much medicine to give your baby when you go home.
Sometimes babies don’t eat well by mouth after surgery and a temporary feeding tube is put in place while they grow.
Heading Home After Surgery
A few things need to happen before you can take your baby home. Your baby has to be able to take all feedings by mouth or with the help of a feeding tube, gain weight normally, and have a normal temperature while he or she is fully dressed in the crib.
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