Overview
Introduction
Picture a newborn who becomes wet sounding, coughs, and turns dusky during the first feed.
Picture a newborn who becomes wet-sounding, coughs, and turns dusky during the first feed. Frothy secretions quickly reaccumulate in the mouth. This pattern is not ordinary feeding difficulty: it suggests that the normal route from mouth to stomach is interrupted and that material may be entering the airway. Esophageal atresia (EA) is a congenital discontinuity of the esophagus. It results from failure of the embryonic foregut to separate normally into the trachea and esophagus. Tracheoesophageal fistula (TEF) is an abnormal connection between those two structures. EA and TEF frequently occur together, often with a fistula connecting the distal esophageal segment to the trachea. The clinical model is straightforward: the blind-ending esophagus traps saliva and feeds above the atresia, while a fistula can send air into the stomach or allow swallowed material to reach the lungs. The immediate nursing concern is aspiration and respiratory compromise, not simply poor feeding. EA occurs in approximately 1–4 per 3,000 live births.