Last updated: 02/17/2009

Diagnosis

A tentative diagnosis of EA/TEF may be made before the child is born. One of the first signs of esophageal atresia may be seen during the mother's prenatal ultrasound examination. Polyhydramnios, which is an excessive amount...

of amniotic fluid surrounding the fetus, is not always diagnostic but offers a warning sign. Fluid is normally exchanged between the fetus and the amniotic fluid through swallowing, urination, and discharges from the nose and mouth. In EA/TEF, the fetus may drool excessively because of a collection of fluid in the abnormal esophageal pouch, thus increasing the amount of amniotic fluid.

A newborn infant suspected of EA/TEF will be given an x-ray examination. The imaging study may reveal a dilated esophageal pouch that is larger than expected because it has collected a pool of amniotic fluid. During fetal development, the enlarged esophagus may also have pressed on and narrowed the trachea, a condition that may contribute to fistula development. Air in the stomach may confirm the presence of a fistula while gas in the large intestine will rule out duodenal atresia. The physician will also perform a comprehensive physical examination, looking for other congenital anomalies that are known to accompany EA/TEF. Chest x-rays may be taken to look for skeletal and cardiac abnormalities. Abdominal X-rays may be taken as well to look for intestinal obstruction and abnormalities. An echocardiogram (ECG) may be performed to evaluate heart function and an ultrasound of the kidneys performed to evaluate kidney function. A nasogastric (NG) tube may be placed in the infant; it may help to confirm a diagnosis of EA/TEF if it stops short of the usual distance (17 cm or about 6.7 in) to the stomach.

Preparation

When an infant is suspected of having EA/TEF, he or she will be transferred from the regular nursery to the neonatal (newborn) or pediatric intensive care department of the medical facility. Corrective surgery must be scheduled immediately to help ensure survival and promote proper swallowing, digestion, nutrition, and breathing. In patients with pneumonia or other lung problems, the doctor may clean out the baby's stomach and esophageal pouch with a suction tube to prevent the baby's stomach contents from being drawn through the fistula and into the trachea. A tube will be placed through the baby's mouth to continuously suction the esophageal pouch during surgery. The baby will be given fluids intravenously during surgery. Oxygen therapy will be administered if needed. An airway will be placed in the trachea if the baby has lung problems. Antibiotics may be given to treat or to prevent infection in the lungs, especially if the stomach contents have been drawn into the lungs. Preoperative blood and urine tests will also be performed.