Term female neonate born via emergent C- section due to non-reassuring fetal heart tracing is unstable at birth and required emergent ETT, NGT, and central.

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Presentation transcript:

Term female neonate born via emergent C- section due to non-reassuring fetal heart tracing is unstable at birth and required emergent ETT, NGT, and central line placement Term female neonate born via emergent C- section due to non-reassuring fetal heart tracing is unstable at birth and required emergent ETT, NGT, and central line placement On prenatal US, pt was found to have hypoplastic left heart, bilateral ventriculomegaly, polyhydramnios, absent stomach bubble, and a single umbilical artery, PDA, and coarctation of the aorta. On prenatal US, pt was found to have hypoplastic left heart, bilateral ventriculomegaly, polyhydramnios, absent stomach bubble, and a single umbilical artery, PDA, and coarctation of the aorta. CXR ordered to assess for tube and line placement showed: CXR ordered to assess for tube and line placement showed: Case Presentation

Hospital course, outcome, surgery path Pt then underwent barium swallow with tube and suction to confirm EA with TEF Pt then underwent barium swallow with tube and suction to confirm EA with TEF Diagnosis: Esophageal atresia with distal TE fistula Diagnosis: Esophageal atresia with distal TE fistula Pt was further evaluated for other VACTERL associated anomalies (Vertebral defect, Anorectal malformation, Cardiac defect, TracheoEsophageal fistula, Renal anomaly, Radial dysplasia and Limb defects), Pt was further evaluated for other VACTERL associated anomalies (Vertebral defect, Anorectal malformation, Cardiac defect, TracheoEsophageal fistula, Renal anomaly, Radial dysplasia and Limb defects), Head US and subsequent MRI (absent corpus collosum with hydrocephalus) Head US and subsequent MRI (absent corpus collosum with hydrocephalus) Renal US (normal) Renal US (normal) Water-soluble contrast enema (normal) Water-soluble contrast enema (normal) Pt underwent thoracotomy to fix TEF and a G-tube was placed. Pt to the OR on 8/18/06 to repair the hypoplastic left heart Pt underwent thoracotomy to fix TEF and a G-tube was placed. Pt to the OR on 8/18/06 to repair the hypoplastic left heart

Radiographic Radiographic Features of EA with distal TEF Radiographic Features of EA with distal TEF Diagnosed by failure of NG tube to pass and by seeing air distally in stomach on XR Diagnosed by failure of NG tube to pass and by seeing air distally in stomach on XR Typically diagnosed by PA and lateral chest images showing coiled NG tube in esophagus Typically diagnosed by PA and lateral chest images showing coiled NG tube in esophagus 5 types 5 types Differentiate by air in stomach and symptoms Differentiate by air in stomach and symptoms May use barium if suspect H-type or EA with double TEF May use barium if suspect H-type or EA with double TEF Dwayne C. Clark, Esophageal Atresia and Tracheoesophageal Fistula. Am Fam Physician 1999 Feb 15;59(4):910-6, Dwayne C. Clark, Esophageal Atresia and Tracheoesophageal Fistula. Am Fam Physician 1999 Feb 15;59(4):910-6,