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Fetal Development and Maternal Diet
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Esophageal atresia may be suspected when the stomach cannot be visualized on a fetal ultrasound and polyhydramnios (an increased quantity of amniotic fluid) is present. However, in up to 90% of cases, a concomitant tracheoesophageal fistula allows fluid to enter the stomach, such that prenatal detection is problematic. More than half have associated anomalies or genetic syndromes. Approximately 10% of cases of esophageal atresia occur as part of the VACTERL association (Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal anomalies, and Limb abnormalities).
Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
Gastroesophageal reflux is very common in children who have undergone repair of esophageal atresia. Decision-making regarding fundoplication is complicated by the decreased esophageal motility in these patients. Pathologic reflux is also more common in infants with congenital diaphragmatic hernia, anterior abdominal wall defects, and malrotation.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Antenatal scans for a 3 day old baby demonstrated polyhydramnios. A chest radiograph following a difficult insertion of a nasogastric tube depicts a coiled tube projected over the mediastinum. The patient has surgical management for oesophageal atresia. A subsequent upper gastrointestinal water soluble contrast study demonstrates a good result but reveals a short narrowing of the duodenum at D2. There are normal calibre gas-filled distal small and large bowel loops. A couple of hemivertebrae are noted.
Clinical Presentations and Diagnostic Imaging of VACTERL Association
Published in Fetal and Pediatric Pathology, 2023
Gabriele Tonni, Çağla Koçak, Gianpaolo Grisolia, Giuseppe Rizzo, Edward Araujo Júnior, Heron Werner, Rodrigo Ruano, Waldo Sepulveda, Maria Paola Bonasoni, Mario Lituania
Kassif et al. have demonstrated that US is a valuable and feasible method to diagnose esophageal atresia during fetal swallowing [47]. If not diagnosed, TEF can cause many early complications such as reactive airway disease and late complications such as recurrence of the fistula [48]. Duodenal atresia, a non-VACTERL phenotype, may be associated in 4-9% of VACTERL patients and can co-exist with esophageal atresia (Figures 9 and 10). In the early neonatal period, TEF can be diagnosed by the inability to pass a nasogastric tube during the first post-natal physical examination. Choking and coughing during feeding, repeating pneumonia, excessive salivation, and cyanosis can also indicate TEF [49]. Clinically, on the infant anteroposterior chest radiogram, failure to pass the gastric tube is the gold standard of TEF diagnosis.
Prenatal Testing: Responsibility and Reality
Published in The American Journal of Bioethics, 2023
Rosamond Rhodes, Matthew J. Drago
The parents choose to move forward with the pregnancy, accepting the risk. However, after birth, the child has a choking episode and turns blue. The medical staff members attempt to place a feeding tube into the baby’s esophagus to remove excess mucous but cannot advance the tube. A chest x-ray shows that the child has esophageal atresia and abnormal vertebrae, likely due to VACTERL association. A whole genome sequence is sent on the baby and the results do not find a trisomy as prenatally suspected, or any other known pathologic genetic variant. VACTERL association is a nonrandom association of congenital anomalies (vertebral defects, imperforate anus, cardiac defects, trachea-esophageal atresia, renal and limb abnormalities) that do not have a clearly understood genetic origin (Solomon 2018). Thus, a child can be born with a medical condition that is likely part of an underlying genetic condition, but unforeseeable given current medical science’s ability to determine its exact genetic origin.
Treatment of two newborns with esophageal atresia and distal tracheoesophageal fistula complicated by gastric perforation: choosing the simple way
Published in Acta Chirurgica Belgica, 2020
Mustafa Okumuş, Adil Umut Zübarioğlu, Reşit Atalan
Although the success in the management of esophageal atresia (EA) has highly improved from 1941 when Cameron Haight performed the first successful primary repair, (EA) still presents unique surgical challenges [1]. One of them is gastric perforation due to excessive air passage via distal tracheoesophageal fistula (TEF). Many preterm newborns with EA require ventilatory support due to respiratory problems. In such cases, maximum attention has been given to minimizing ventilation through the fistula, usually by placing the end of the endotracheal tube distal to it, in order to prevent gastric distention/perforation and ventilatory compromise [2,3]. When the gastric perforation occurs, urgent intervention, such as a gastrostomy, fistula ligation or occlusion is needed [1–7]. Pneumoperitoneum and ventilatory compromise can make the clinical condition worse and in those cases, all attempts may be much more difficult. Sometimes simple temporary solutions can be useful for stabilization and allow safety for required surgical treatment for later. Two cases intervened initially by a simple peritoneal drain were presented.