Esophageal Atresia and Tracheoesophageal Fistula
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What is esophageal atresia (EA) and a tracheoesophageal fistula (TEF)?
An esophageal atresia (EA) and a tracheoesophageal fistula (TEF) are 2 disorders of the digestive system. The condition affects babies. It starts while the mother is pregnant. This makes it a congenital defect. The 2 disorders often happen together.
An EA is when the esophagus doesn’t connect to the stomach. TEF is when the esophagus and windpipe (trachea) have an incorrect connection. The poor connection is called a fistula. There are several types of EA. An EA sends the baby’s nutrients to a pouch. So, nothing the baby swallows enters the stomach. With a TEF, food or milk can get into your baby’s lungs when they swallow. This can cause breathing problems and even pneumonia.
About 1 baby out of 4,000 babies has one or both of these problems. Sometimes a baby is born with one and not the other.
Babies with this condition can breathe saliva and other fluids into their lungs. This can cause pneumonia, choking, and even death. Being born prematurely may make the condition worse.
The main problems EA causes are with the digestive system. TEF usually causes breathing problems. Symptoms of EA/TEF include:
- Feeding problems upon birth
- Frequent drooling or spitting up
- Bubbly mucus in the mouth
- Coughing, gagging, or choking when feeding
- Bluish skin color when feeding
- Difficulty breathing
Most babies with EA develop symptoms right after birth. For babies who have TEF but not EA, symptoms are mild and could take weeks to diagnose.
CAUSES & RISK FACTORS
What causes EA/TEF?
Healthcare providers are not yet sure exactly what causes these problems. While pregnant, your child’s esophagus and the trachea start to grow from the same bit of tissue. Sometimes the tubes don’t develop correctly. It’s not thought that these problems are inherited. In some cases, a baby with EA/TEF have a heart defect.
DIAGNOSIS & TESTS
How is EA/TEF diagnosed?
An ultrasound during pregnancy is the first clue. If there is too much amniotic fluid (the fluid that surrounds the baby), the baby may have a blockage in their digestive system. The blockage could be an EA.
If your healthcare provider suspects EA after the baby is born, they can insert a feeding tube through your baby’s mouth or nose. The tube normally goes down to the stomach. If it can’t reach the stomach, your healthcare provider will probably diagnose your baby with EA. An X-ray can detect air in the esophagus, stomach, and intestine. It can help confirm the diagnosis. An X-ray can also help confirm TEF.
There is nothing a woman who is pregnant can do to prevent her baby from developing EA/TEF before birth. The best thing they can do is to take good care of themselves while pregnant. This includes:
- Eating a healthy diet
- Getting plenty of rest
- Attending all scheduled healthcare provider appointments
EA/TEF is an emergency situation. Your baby will need surgery to fix the problem. If your baby has EA, the swallowing tube must be connected to the stomach. If a fistula is connecting the esophagus to the trachea, it must be closed. Your child’s healthcare provider will decide when to do the surgery. Healthy, full term babies can have the surgery at just a few days old. If the baby has any other problems (such as pneumonia or other birth defects), surgery may have to wait.
In uncomplicated cases, your baby may start eating as soon as one week after surgery. Until your baby can swallow milk or formula, your baby will be fed through an IV or a stomach tube. Your baby will stay in the hospital during this time. Recovery time could be longer if your baby was born premature or the operation was complicated.
Living with EA/TEF
Infants with EA/TEF often have another problem called tracheomalacia. This is a weakness and floppiness to the walls of the windpipe. It can cause their breathing to be noisy or sound high-pitched.
Some babies who have esophageal atresia also have other problems. These include:
- Heart problems
- Kidney problems
- Stomach and bowel problems
- Muscle and bone problems
Your healthcare provider may do a physical exam of your baby. They may order more X-rays or ultrasound tests. These usually show if your baby has other problems. Babies with other problems might have to get those fixed first. Then they can have the surgery to fix the swallowing tube.
Babies born with esophageal atresia sometimes have long-term problems, including:
- Gastroesophageal reflux disease, or GERD. This is similar to heartburn. It can usually be treated with medicine.
- Scar tissue. Sometimes scar tissue grows where the esophagus connects to the stomach. This can make swallowing hard or painful. Food can’t easily get past it. Surgery may be necessary to open the scar tissue. This might require more tests or a procedure to see inside the esophagus and stomach.