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Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 71-74

Experience of tracheo-esophageal fistula in neonates in a Tertiary Care Center - Case series

1 Department of Neonatology, Dr. Bidari's Ashwini Hospital, Vijayapura, Karnataka, India
2 Department of Pediatrics Surgery, Dr. Bidari's Ashwini Hospital, Vijayapura, Karnataka, India
3 Department of Pediatrics, Dr. Bidari's Ashwini Hospital, Vijayapura, Karnataka, India

Correspondence Address:
Dr. Siddu Charki
Department of Neonatology, Dr. Bidari's Ashwini Hospital, Vijayapura, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcn.JCN_69_18

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Introduction: Tracheoesophageal fistula (TEF) is one of the most common neonatal emergencies. The most common presentation being polyhydramnios detected antenatally, excessive salivation and vomiting, respiratory distress after birth, recurrent pneumonia later in life. The incidence is 1 in 3000 to 1 in 4500 live births. Clinical Profile: Of 1206 admissions in 2017 to the neonatal intensive care unit (NICU), 51 required surgery. Out of which 11 babies were diagnosed with TEF and were subjected to surgery. Antenatal scans revealed polyhydramnios in four babies. Nine babies were born at term with an average weight of 2–2.5 kg and two babies were born preterm at 30 weeks (1.3 kg) and 32 weeks (1.8 kg). Eight babies presented on day 1–2 of life and three babies on day 2–3. The most common clinical presentation was excessive frothing from the mouth noticed since birth and respiratory distress. Nine babies (82%) presented with chest infection of varying severity. Only two babies (18%) had a clear chest. Babies were stabilized in NICU and connected to Replogle tube with continuous negative suction. All babies were subjected to surgery within 24 h of admission. Type C was the most common. Babies were subjected to contrast study to rule out anastomotic leak. Feeding initiated after 72 h of life and was gradually started on trophic feeds and reached full feeds. Outcome: Out of 11 babies, 9 babies recovered and were discharged. One baby was discharged against medical advice and one baby died due to sepsis. Growth is satisfactory and development has been normal at 1 year of age in all discharged babies at follow-up. Discussion: Success in the survival of neonate with TEF is attributed to improved neonatal intensive care with surgical advances and postoperative care. Early recognition, prompt and efficient management of the cases was possible due to multidisciplinary approach by neonatologist, intensivist, and the surgeon. A precise surgical technique with proper mobilization of upper pouch and good anastomosis is key events.

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