Clinical context (Neonate with excessive drooling, choking/coughing with first feed, inability to pass NG into stomach — types: A pure atresia; B proximal fistula; C distal TEF (most common); D double fistula; E H-type — all require NPO, suction, urgent pediatric surgery)
Duration: Until transfer / definitive care · ABCDE; keep NPO; place Replogle or continuous suction of upper esophageal pouch; head-up 30–45°; avoid blind repeated NG attempts if TEF suspected; prevent aspiration; urgent pediatric surgery — repair gap depends on type but primary care tactics identical
Supportive care — antibiotics only if aspiration pneumonia suspected • —
Duration: Until repair · Ampicillin + gentamicin if respiratory distress with suspected aspiration pneumonia before surgery — not routine for uncomplicated EA (APSA)
Clinical notes
• Recognition: maternal polyhydramnios history, drooling, choking with first feed, coiling of NG on chest X-ray, air in stomach if distal TEF present.
• EA types (Gross): A — blind proximal and distal pouches; B — proximal fistula only; C — distal TEF (≈85%); D — double fistula; E — H-type fistula without atresia — surgical repair differs but initial stabilization is the same.
• Primary care: NPO, upper pouch suction, head elevation, minimize oral secretions aspiration; warm and monitor.
• Do NOT: give oral feeds; force NG passage; lay flat; delay transfer for full workup if diagnosis likely.
• Associated anomalies (VACTERL) common — communicate on transfer; echocardiography at receiving center.
• APSA — Esophageal atresia and tracheoesophageal fistula (2024)
• AAP — Neonatal surgical emergencies (2024)
• WHO Pocket Book — Newborn feeding difficulties and surgical conditions (2022)
