Snapshot A newborn child is brought to the emergency room with excessive drooling, as well as coughing and choking during feeding. The physician notes cyanosis that is unrelieved by crying. Bilateral pulmonary rales are appreciated on exam. There is also abdominal distension with tympany on percusion. Introduction Congenital anomaly resulting in a tract between the trachea and esophagus Associated with esophageal atresia and other VACTERL anomalies including vertebral anal cardiac tracheal esophageal renal limb defects Epidemiology occurs in roughly 1:4000 births Presentation Symptoms increased oral secretions feeding difficulty gagging/choking hyperventilation or other respiratory dysfunction Physical exam respiratory distress polyhydramnios in utero rales on pulmonary ausculation cyanosis abdominal distention caused by swallowing air during feeding Evaluation CXR may show NG tube coiled in esophagus KUB may identify air in the GI tract Bronchoscopy confirms anatomic abnormality (i.e. narrowing of esophagus and/or fistula) Prenatal Ultrasound may show polyhydramnios Differential Esophageal atresia Treatment Surgical intervention surgical repair considered a surgical emergency when identified prevents further lung damage Prognosis, Prevention, and Complications Prognosis good outcome with early prognosis and treatment Prevention no preventive measures are available at this time Complications aspiration pneumonia choking esophageal stricture post-operatively reflux post-operatively