A Case Report of Congenital Oesophageal Atresia with Tracheo-Oesophageal Fistula and Review of the Literature.
The congenital lack of the oesophageal connection with the stomach in OA prevents swallowing, and this in turn prevents normal feeding and may cause the baby to aspirate accumulated saliva or milk leading to aspiration pneumonia. The incidence of COA is 1 case in 3000-4500 births. Maternal polyhydramnios occurs in approximately 33% of mothers with foetuses with OA and distal TOF and in virtually 100% of mothers with foetuses with OA without TOF.
The characteristic presentation of babies with OA is with drooling and excessive oral secretions with or without overt respiratory distress. The baby will typically choke upon starting breast or bottle feeding. This may progress to significant respiratory distress. The diagnosis of OA should be highly suspected if a large bore gastric tube appearance on a plain chest radiograph shows the tube to coil back in the proximal oesophageal pouch. OA occurs in association with other significant congenital anomalies in 30-60% of babies. The associated congenital anomalies are the major source of morbidity and mortality associated with OA. Early identification and management of OA prevents respiratory compromise and improves the outcome.
The post-natal clinical presentation of undiagnosed OA is variable but primarily reflects the effect of inability to swallow milk or the baby’s own oral secretions. Frothy secretions which do
not clear or recur after suction are typical findings in the majority of cases of OA. Some babies present with respiratory distress, choking and oxygen desaturations due to the reflux.
Pediatr Neonatal Nurs Open J. 2021; 7(1): 8-12. doi: 10.17140/PNNOJ-7-132
