Because of the esophageal obstruction, the infant is unable to handle secretions, with subsequent “excess salivation” and aspiration of pharyngeal contents. Communication between the tracheobronchial tree and the distal fistula allows the crying newborn to greatly distend the stomach with air. This impairment of diaphragmatic excursion can promote basilar atelectasis and respiratory distress. Additionally, the distal TEF permits reflux of gastric secretions directly into the tracheobronchial tree, causing chemical pneumonitis or pneumonia.