the time. Because there is an intact esophagus, these children typically present days to
weeks later after birth with symptoms of intermittent aspiration. The least common
types are EA with a proximal fistula (1%) and EA with proximal & distal TEF (1%).
In a child with pure EA or EA with proximal fistula only, NO air is seen in the
stomach on a babygram. In a patient EA with distal TEF or a proximal and distal
(double) fistula, inhaled air goes through the fistula and gets into the GI tract; there is
presence of air in stomach. In a patient with H-type fistula, there is usually a delay in
diagnosis, since the baby is often able to tolerate some feeds. The clinical scenario is a
baby with episodic aspirations sometimes associated with apnea. To rule out an H tupe
fistula a CAREFUL esophragram with an experienced pediatric radiologist is usually
needed. Alternatively or in addition, a bronchoscopy would also show the fistula.
Preoperative Management
Position upright at 30-45 degree angle
Replogle suction to esophageal pouch
Respiratory support
Suction airway as needed
Intubation, if necessary
Evaluate for other anomalies
VATER/VACTERLA Replogle tube is different from a regular Salem sump tube. A Replogle only has holes
in the distal 1-2 cm,accommodating the length of the esophageal pouch in a newborn.
A regular Salem sump has holes along a longer length. If a Salem sump were to be