Amale baby was delivered at term by elective caesarian section due topolyhydraminos.
At delivery, the infant was vigorous, birth weight 2.3Kg andhad APGAR score 9 at one minute and 10 at five minutes. The initial physicalexamination at one hour of life was remarkable only for a slight increase inwhite oral secretions which were cleared with suction. The baby passed meconiumwithin the first two hours of life but he refused to take milk orally anddespite of this, his abdomen became distended gradually. At approximately fourhours of life, the infant was noted to have some crackles on routineauscultation. Respiratory rate was normal. He had drooling of saliva.Clinically, EA was suspected and an attempt was made to pass an OG tube withradio-opaque marker.
A chest radiograph was obtained (figure:1) which showed OGtube failed to reach the stomach. Nasogastric aspiration revealed a copious,mucus like aspirate. A diagnosis of EA with probable TEF was made by seeingpresence of gas in abdomen in x ray.
Routine echocardiography showed theabsence of cardiac malformation. No other associated anomalies were notedexcept deformed left pinna. Initially, he was prepared for surgery withparenteral nutrition, propped up position and continuous upper esophagealsuction. The patient underwent surgery on the third day of life. A rightlateral thoracotomy incision was made and chest cavity opened through 4thintercostal space. By extrapleural approach with single lung ventilation,posterior mediastinum was exposed and the azygos vein was identified anddivided between the ties.
Type “C” EA with moderately long long gap (>2 cm) distalTEF was identified and an ligation of TEF followed by end to end anastomosis ofthe esophagus was done which was also checked by giving normal saline into theposterior mediastinum and no air bubble was seen. Then an intercostal chesttube drain was left in situ and wound was closed in layers. The postoperativeperiod was uneventful. He was extubated from ventilator on 2nd postoperative day (POD).
Thebaby made excellent recovery and was discharged on 12th POD withdomperidone and H2 blocker medicine for prevention of GERD. Followup examination upto the age of 3 yearsrevealed he was gaining weight normally, having no problem in swallowing,achieving normal development.