What Are Tracheoesophageal (TE) Fistula and Esophageal Atresia?
A tracheoesophageal fistula and esophageal atresia happen when two throat tubes
don't develop properly before birth. The tubes are:
the trachea (windpipe), which carries oxygen into the lungs
the esophagus, which carries food to the stomach
Most babies with a tracheoesophageal fistula (TE fistula) also have esophageal
atresia. These can cause breathing and feeding problems at birth, so they need treatment
Surgery done soon after birth can fix both problems. But babies with esophageal
atresia may need more surgeries.
What Happens in a Tracheoesophageal Fistula?
A tracheoesophageal fistula (tray-kee-oh-eh-sof-uh-JEEL FISS-chuh-luh) is an unusual
connection that goes between the trachea and esophagus. Normally, these two tubes
are side-by-side and closed off from each other. But when a baby has a TE fistula,
these tubes share a pathway.
So, when a baby drinks breast milk or formula, it goes down the throat and can
get into the lungs. When a baby breathes, air can fill the stomach. Stomach acids
can back up into the lungs. This can cause:
A baby with a small TE fistula and no esophageal atresia may not have symptoms
at birth. But when that child is older, he or she could have:
poor weight gain
frequent lung infections
What Happens in Esophageal Atresia?
Esophageal atresia (ih-sof-uh-JEEL ah-TREE-zah) happens when the upper part of
the esophagus does not connect to the lower part. This causes a blockage, so saliva
(spit) and food can't go down into the stomach.
Babies with esophageal atresia have:
What Causes a Tracheoesophageal Fistula and Esophageal Atresia?
Doctors don't know exactly what causes these problems. It's likely a combination
something in the environment during a woman's pregnancy that changes the way the
trachea and esophagus form
About half of babies born with a TE fistula and esophageal atresia have no other
problems. Some babies born with a TE fistula will have other health issues, like heart or kidney
problems. A TE fistula and esophageal atresia are more common in babies with a genetic
condition like Down
syndrome (trisomy 21).
How Are Tracheoesophageal Fistula and Esophageal Atresia Diagnosed?
These problems usually are diagnosed before a baby is born on a prenatal
ultrasound. If not, doctors will suspect a problem at birth if a baby:
drools a lot
has frothy mucus in the mouth and nose
The baby also might cough, choke, throw up, or turn blue, especially when feeding.
To diagnose esophageal atresia, doctors will try to pass a tube through the baby's
nose or mouth into the stomach. If the tube cannot reach the stomach, esophageal atresia
Because these babies are more likely to have other health conditions, doctors also
check for problems with a baby's bones,
heart, and other organs.
How Are Tracheoesophageal Fistula and Esophageal Atresia Treated?
Both conditions are treated with surgery:
If a baby is born with a TE fistula, surgeons will remove the fistula and close
the opening between the trachea and esophagus soon after birth.
If a baby also has esophageal atresia, doctors usually fix it during this surgery
as well. If the two ends of the esophagus are close, surgeons sew them together. If
the ends are farther apart, doctors may wait to repair the esophagus. The ends often
grow closer together as a baby gets older. Some babies may need procedures to make
the esophagus longer.
Sometimes babies with esophageal atresia get a gastrostomy
tube (G-tube) until surgeons can repair the esophagus. A G-tube goes in through
the belly to deliver breast milk or formula right to the stomach.
A medical team cares for babies with TE fistula and esophageal atresia. Sometimes
called an aerodigestive team, it includes specialists who: