Dr. MJ Bazos MD,
and Tracheoesophageal Fistula
In babies with esophageal atresia, the esophagus
doesn't connect to the stomach. It just ends in a pouch, so nothing the baby
swallows gets into the stomach. (This is how you say these words:
What is a
A fistula is a connection between 2 tubes. The
breathing tube that connects the nose and mouth with the lungs is called the
trachea. The swallowing tube is the esophagus. The breathing tube and the
swallowing tube aren't supposed to be connected. But when a child has a
tracheoesophageal fistula (say "tray-key-oh-ee-sof-ah-gee-all fist-you-lah"),
the fistula connects the 2 tubes. This means that food or milk in the stomach
can get into the lungs. This can cause breathing problems and even pneumonia
atresia and fistula?
We don't really know what causes these problems.
When the esophagus and the trachea grow in the embryo, they start from the same
bit of tissue. Sometimes the tubes don't develop right. We don't think these
problems are inherited.
Are these problems
About 1 baby out of 4,000 babies has one or both
of these problems. They usually occur together. But sometimes a baby has atresia
with no fistula.
How does the
doctor know this is what's wrong with my baby?
Most babies with this condition have feeding
problems right away. They may spit up a lot or have lots of bubbly mucus in
their mouth. If your baby has a fistula, breathing may be hard. If your doctor
thinks your baby has one of these conditions, an x-ray can help make the
How is this
Your baby will need surgery to fix the problem.
First, the swallowing tube must be connected to the stomach. Then, if a fistula
is connecting the esophagus to the trachea, it must be closed. Your child's
doctor will decide when to do the surgery. If the baby isn't premature and
doesn't have any other problems (like pneumonia or birth defects), the surgery
can usually be done when the baby is just a few days old.
How long will my
baby be sick?
In uncomplicated cases, your baby may be eating
by one week after surgery. Meanwhile, until your baby can swallow milk or
formula, your baby will be fed through a vein (this is called an "IV") or
through a stomach tube. Before regular feeding starts, an x-ray can check for
holes at the place the surgeon fixed.
However, if your baby was premature, the
recovery time might be a little longer. Another factor is how complicated the
operation is. If the surgery is harder, it takes a few days longer for your baby
to recover. Your baby will stay in the hospital during this
Does my baby have
any other problems?
Some babies with esophageal atresia have heart
problems, kidney problems, stomach and bowel problems, or muscle and bone
problems. A physical exam by your doctor, maybe with some other x-ray or
ultrasound pictures, will usually show if your baby has other problems. If your
baby has other problems, the surgery to fix the swallowing tube might have to
Will my baby have
other problems in the future?
Babies born with esophageal atresia sometimes
have long-term problems. Probably the most common problem is gastroesophageal
reflux disease, or GERD. GERD is what doctors call heartburn. Heartburn is a
burning feeling caused by acid that comes up from the stomach into the
swallowing tube. It can usually be treated with medicine.
Another problem is scar tissue. Sometimes scar
tissue grows where the esophagus connects to the stomach. This scar tissue can
make swallowing hard or painful because the food can't get past the scar tissue
easily. Sometimes another surgery is needed to open the scar
Your child may need more x-rays or endoscopy
later. Endoscopy is a way of taking a picture. A narrow tube holding a tiny
camera is put into the swallowing tube. The picture helps your doctor see inside
the esophagus and stomach.