Neonatology - Oesophageal Atresia

Question 1

Oesophageal atresia Definition

Answer 1

Congenital disorder in which the oesophagus terminates in the blind-ended pouch rather than connecting normally to the stomach.

Question 2

Tracheo-oesophageal fistulas defintion

Answer 2

Abnormal communication between the trachea and oesophagus

Question 3

Aetiology

Answer 3

Unknown

Question 4

Pathophysiology Oesophageal atresia

Answer 4

Condition where the oesophagus, the tube that connects the mouth to the stomach, does not form as a continuous passage. Instead, there is a break or discontinuity in the oesophagus. During embryonic development, the oesophagus typically forms as a continuous tube that connects the mouth and the stomach.
In OA, this process is disrupted, resulting in a gap or atresia in the oesophagus. Because the oesophagus is not connected, infants with OA are unable to swallow and pass food or liquids from their mouth to their stomach. This leads to excessive drooling and difficulty in feeding. Pathophysiology
Due to the proximity of the trachea (windpipe) and oesophagus, there is a risk that the blind-ending upper oesophageal pouch may compress the trachea, causing airway obstruction.

Question 5

Pathophysiology tracheo-oesophageal fistulae

Answer 5

TOF is often associated with OA and is a communication or connection between the trachea and the oesophagus. In TOF, there is an abnormal connection (fistula) between the trachea and the oesophagus. This connection typically occurs close to the blind-ending upper oesophageal pouch in infants with OA. Because of the tracheoesophageal fistula, stomach contents, including gastric acid, can flow into the trachea and enter the lungs. This can lead to respiratory symptoms, such as coughing, choking, and increased risk of pneumonia.

Question 6

Symptoms

Answer 6

Antenatal s + s:
- Polyhydramnios: the baby’s inability to swallow and absorb amniotic fluid due to blind-ending oesophagus can lead to excessive accumulation of this fluid, resulting in polyhydramnios

Postnatal s + s:
- Respiratory distress
- Distended abdomen
- Choking or problem with swallowing as see by difficulty in feeding or excess saliva
- Difficulty in passing a nasogastric tube is a common sign noted

Question 7

Diagnosis

Answer 7

Radiographic examination = coiled nasogastric tube on an anteroposterior chest radiograph, can help in diagnosing oesophageal atresia
Echo + renal USS recommended = associated congenital anomalies
Genetic counselling

Question 8

Differential diagnosis

Answer 8

Congenital diaphragmatic hernia,
Duodenal atresia,
GORD

Question 9

Treatment

Answer 9

The management of oesophageal atresia primarily involves surgical intervention to correct the anatomical abnormalities. This can be performed soon after birth to connect the two parts of the oesophagus and close off any fistula with the trachea.
● Postoperative care involves monitoring for complications such as anastomotic leaks, strictures, or recurrent fistula, and managing nutritional and respiratory support as required.