Academic Editor: Divey Manocha
Affilation: Upstate Medical University
Unusual Presentation Of Tracheosophageal Fistula With Meconium Aspiration Syndrome In A Preterm Infant
Congenital malformations usually occur during organogenesis and result in complete or partial absence of an anatomical part or alteration in its normal configuration. Major structural anomalies occur in 2-3% of live births. The reported global incidence of tracheoesophageal fistula is roughly 1 in 2,500 live births and in Pakistan, incidence is only reported by those tertiary care centers which have paediatric surgery facilities available.We report a case of esophageal atresia (OA) with tracheoesophageal fistula (TEF) associated with meconium aspiration syndrome (MAS) in an infant. Reporting this anomaly highlights the importance of early diagnosis and thorough clinical examination of a newborn, signifying that a meticulous prenatal workup should be conducted. TEF/OA should be suspected in any newborn presenting with respiratory distress, especially cough, emesis and/or cyanosis during feeds, history of polyhydrominos and inability to pass nasogastric tube. The parents should also be counseled regarding future pregnancies as it carries a 1% risk of recurrence.
Here we present a case TEF with OA, associated with meconium aspiration syndrome (MAS) in an infant. We aim to highlight the importance of conducting a comprehensive antenatal and prenatal workup in newborns to avoid management difficulties after birth and prevent an avoidable fatality. Also, to highlight an early diagnosis if a baby has respiratory distress and
Her mother was a primigravida with no significant prenatal history except hypertension in
On examination, the baby was sick looking, lethargic, with poor reflexes. She had a respiratory rate of 82/min, heart rate of 180/min, a temperature of 100o C, was cyanosed with yellowish staining of nails, but no anemia or jaundice. No signs of dehydration were present and her lymph nodes were not
After suctioning of oropharynx was performed we passed a nasogastric tube into the baby gently but beyond a certain
The child was placed on oxygen, given IV hydration and antibiotic therapy. As her condition improved, a barium esophagogram with contrast was performed to confirm the diagnosis which showed: distended stomach and proximal small bowel loops; nasogastric tube curling over itself at D4 level; and evidence of a
Suddenly, during the procedure the baby collapsed; She was cyanosed, gasping for breath and was placed on the ventilator immediately. She required frequent suctioning onwards due to excessive secretions and a call was sent to another tertiary care center with
On the 10th day of life, the baby’s condition deteriorated further despite all efforts. Unfortunately, she stopped breathing, her pupils became fixed and dilated and all efforts to resuscitate her failed.
This sad news was conveyed to the parents and they were counseled for future pregnancies regarding the risk of recurrence.
Congenital malformations usually occur during organogenesis resulting in
This case report presented has shown TEF with blind ending esophageal pouch with a fistula from
Mastroiacovo et al5 found that out of 92 malformations studied, 39 malformations including TEF/OA were more common in twins than in singletons and in males. Chromosomal anomalies like trisomy 18 and 21 also predispose to this condition. Even more recently, three genes associated with TEF/OA in humans have been identified.1 In our case, the child was a singleton, female and no other obvious dysmorphic features were seen. CHARGE and VACTERL were excluded. Karyotyping and any other chromosomal analysis couldn’t be done due to lack of funding.
According to Waterston classification our case was type B and
The incidence of other anomalies associated with TEF/OA is reported to be 30-60%.7 Children with TEF have a higher incidence of pyloric stenosis
In the postnatal
Surgical management includes Neonatal Intensive Care Unit and appropriate anesthesia, which is available in developed countries and has an almost 100% survival rate as compared to low-income settings that exist in countries like ours, where all discipline facilities including prompt surgical intervention, ventilator
The outcome is generally better for term babies 12 than preterm. The death in our case reported was most probably due to low birth weight, prematurity, septicemia and inadequate management modalities.
This case highlights the significance of conducting a comprehensive clinical examination in newborns; meticulous prenatal workup is also necessary to reduce fatalities. TEF/OA should be suspected in any newborn presenting with respiratory distress, persistent drooling, a history of
Consent: Written informed consent was obtained from the parents of the baby for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.