TRACHEOESOPHAGEAL FISTULA (TOF)

This is an anomaly in the development of the oesophagus in which there is usually a proximal atresia with a distal tracheoesophageal fistula.

This condition is an emergency. It must be diagnosed within the first 24 hours of birth.
Diagnosis is best done before the baby is fed to prevent aspiration of feeds.

Clinical Features

  • Tracheoesophageal fistula is suspected:
    • When there is history of polyhydramnios.
    • When saliva drools continuously from the mouth.
    • Where there is respiratory distress
  • For such a baby exclude TOF before feeding is initiated. If feeding is inadvertently started in such a baby:
    • Attacks of coughing and cyanosis (choking) are likely to occur.
    • The abdomen is likely to be distended especially at the epigastrium (due to swallowed air in the stomach).

Investigations

Insert nasogastric tube and with a tube in-situ, do x-ray that includes the neck, chest, and abdomen.

Management

Once diagnosis is made, do the following:

  • DO NOT feed the baby enterally.
  • Keep the baby warm.
  • Institute intermittent suction/continuous drainage using the N/G tube to clear the secretions from the pouch.
    • Turning the baby to the side if possible to facilitate drainage.
    • Placing the baby in the head-up position to prevent gastric juice reflux.
    • Initiating intravenous infusion with 10% dextrose solution.
  • Arrange for urgent transfer to a specialist centre that is equipped for this type of operation.
  • Transport the baby should under the above circumstances. It is important to communicate on telephone with the respective surgeon before any movements are made.

Note: There are certain congenital abnormalities that are commonly associated with TOF. These are vertebral, anal, trachial-oesophageal, and renal abnormalities, generally referred to as Vater syndrome.

Surgery may be carried out immediately after birth in a well baby. In some other cases gastrostomy is necessary to allow time for correction of intercurrent conditions. Adequately counsel the parents or guardians with respect to this.