Experience of TRACHEO-ESOPHAGEAL FISTULA in Neonates in a Tertiary Care Centre: Retrospective Case Series Study

Introduction: Tracheo-esophageal fistula is one of the most common neonatal emergencies. The most common presentation being Polyhydramnios detected antenatally, excessive salivation and vomiting, respiratory distress after birth, recurrent pneumonia later in life. The incidence is 1 in 3000 to 1 in 4500 live births.

Clinical Profile: Out of 1206 admissions in 2017-2108 to NICU, 51 required surgery. Out of which 11 babies were diagnosed with tracheo-esophaegal fistula and were subjected to surgery. Antenatal scans revealed Polyhydramnios in 4 babies. 9 babies were born at term with average weight of 2-2.5 kg and 2 baby were born preterm at 30weeks (1.3kg) and 32 weeks (1.8kg). 8 babies presented on day 1-2 of life and 3 babies on day 2- 3. Most common clinical presentation was excessive frothing from the mouth noticed since birth and respiratory distress. 9 babies (82%) presented with chest infection of varying severity. Only 2 babies (18%) had clear chest. Babies were stabilized in NICU and connected to Replogle tube with continuous negative suction. All babies were subjected to surgery within 24 hours of admission. Type C was the most common. Babies were subjected to contrast study to rule out Anastomotic leak. Feeding initiated after 72 hours of life and was gradually started on trophic feeds and reached full feeds.

Outcome: Out of 11 babies, 9 babies recovered and were discharged. 1 baby was discharged against medical advice and 1 baby died due to sepsis. Growth is satisfactory and development has been normal at 1 year of age in all discharged babies at follow up.

Discussion: Success in survival of neonate with tracheo-esophageal fistula is attributed to improved neonatal intensive care with surgical advances and postoperative care. Early recognition, prompt and efficient management of the cases was possible due to multidisciplinary approach by neonatologist, intensivist and the surgeon.