TY  - CHAP
M1  - Book, Section
TI  - Surgical Diseases of the Newborn: Alimentary Tract Obstruction
A1  - Gomella, Tricia Lacy
A1  - Eyal, Fabien G.
A1  - Bany-Mohammed, Fayez
PY  - 2020
T2  - Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 8e
AB  - DefinitionsType  C  esophageal  atresia  is  the  most  common  type,  accounting  for  up  to  85%  of  cases.  It  consists  of  proximal  esophageal  atresia  with  distal  tracheoesophageal  fistula.Type  A  esophageal  atresia  is  the  second  most  common  type,  accounting  for  about  10%  of  cases.  This  is  a  pure  esophageal  atresia  without  fistula.Other  forms  of  esophageal  atresia  are  less  common.PathophysiologyEmbryologic  failure  of  migration  and  separation  of  longitudinal  tracheoesophageal  fold.  Normally,  folding  results  in  larynx  and  trachea  anteriorly  and  esophagus  posteriorly.Clinical  presentationPolyhydramnios  due  to  proximal  esophageal  obstruction;  fetus  cannot  swallow  amniotic  fluid.Neonates  display  feeding  intolerance,  excess  salivation,  and  respiratory  distress  from  aspiration  of  feeds.In  type  C,  gastric  distention  may  cause  respiratory  compromise,  and  gastric  reflux  into  airway  may  cause  chemical  pneumonitis  and  pneumonia.DiagnosisPrenatal  ultrasound  may  show  small  or  absent  gastric  bubble  if  pure  esophageal  atresia.Inability  to  pass  an  orogastric  tube.  The  chest  radiograph  shows  an  orogastric  tube  in  the  proximal  esophagus.  Air  below  the  diaphragm  confirms  presence  of  a  distal  fistula.VATER/VACTERL  association  (vertebral  defects,  anal  atresia,  tracheoesophageal  fistula,  and  radial  or  renal  dysplasia/vertebral  defects,  anal  atresia,  cardiac  malformations,  tracheoesophageal  fistula,  renal  dysplasia,  and  limb  abnormalities)  workup  necessary.ManagementPreoperative  optimization  is  focused  on  minimizing  risk  of  aspiration  and  gastric  distention.Place  Replogle  tube  in  proximal  esophageal  pouch  to  evacuate  oral  secretions.Keep  baby  in  upright  position  (45  degrees)  to  lessen  risk  of  reflux  and  aspiration.If  possible,  avoid  positive-pressure  ventilation.If  mechanical  ventilation  is  necessary,  low  tidal  volumes  and  inspiratory  pressures  are  preferable.  In  select  babies,  high-frequency  oscillatory  ventilation  may  provide  gentler  ventilation.Broad-spectrum  antibiotics  should  be  administered.VATER/VACTERL  association  workup  should  be  performed.  This  includes  an  echocardiogram  prior  to  surgery  to  assess  for  cardiac  and  aortic  arch  anomalies.Goals  of  operative  therapy  are  to  ligate  fistula  and  establish  esophageal  continuity  if  possible.Repair  via  open  or  thoracoscopic  techniques.If  long-gap  esophageal  atresia  (>3  vertebral  bodies)  is  present,  one  may  not  be  able  to  perform  immediate  esophageal  anastomosis  and  a  gastrostomy  tube  should  be  placed.If  defect  cannot  be  bridged  with  native  esophagus,  use  of  gastric  or  intestinal  conduits  may  be  necessary.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/25
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1168358355
ER  -