Tracheoesophageal Fistula and Congenital Hernias

Excessive frothy mucus from the nose and mouth, coughing, choking, cyanosis, apnea, and increased respiratory distress during feeding.

Maintaining a patent airway, preventing aspiration, gastric decompression, providing supportive therapy, and surgical repair.

Withhold oral intake, initiate IV fluids, position the infant for drainage, suction accumulated secretions, insert a double-lumen catheter, keep the head upright, consider broad-spectrum antibiotics

Thoracotomy, ligation of the fistula, esophageal anastomosis (end-to-end or end-to-side), chest tube placement if needed

Condition where the esophagus doesn't fully form, often accompanied by a fistula to the trachea.

A birth defect where abdominal organs move into the chest cavity through an opening in the diaphragm.

Muscle separating the chest and abdomen, crucial for breathing.

1 in 3,000 live births.

50% of CDH cases have additional birth defects.

High; approximately 40% death rate.

Infants with diaphragmatic hernia need adequate intravenous fluids to stay hydrated before surgery.

After surgery, infants with diaphragmatic hernia should be positioned on their unaffected side to help their good lung expand.

The success of diaphragmatic hernia repair depends largely on the size of the hole in the diaphragm.

Babies with diaphragmatic hernia need immediate respiratory support because their lungs are squished by abdominal organs.

Children who survive diaphragmatic hernia surgery need regular checkups to monitor their lungs, growth, and development.

A congenital anomaly where the esophagus doesn't fully develop, often with a connection to the trachea.

Defective separation or fusion of tracheal folds during fetal development. Altered cellular growth can also contribute.

The upper esophagus ends in a blind pouch, while the lower end connects to the trachea via a fistula near the bifurcation.

Both ends of the esophagus form blind pouches, with no connection to the trachea.

A fistula connects a normal esophagus to a normal trachea.

Excessive frothy mucus, coughing, choking, cyanosis, apnea, and respiratory distress during feeding.

A radiopaque catheter is inserted into the hypopharynx to check for obstruction. Chest X-rays assess esophageal patency and the presence of a blind pouch.

High amniotic fluid levels in the uterus are a sign of EA, as the baby cannot swallow and absorb the fluid.

A birth defect where the esophagus doesn't fully form, leaving a gap in the food pipe.

A connection between the windpipe (trachea) and the esophagus, causing food or fluid to enter the lungs.

There are five main types of EA/TEF, classified by the presence and location of connections between the esophagus and trachea.

An acronym describing a set of associated birth defects including: Vertebral, Anal, Cardiac, Tracheal, Esophageal, Renal, and Limb anomalies.

Excessive amniotic fluid during pregnancy, often seen in mothers of infants with EA/TEF.

Surgical approach for long gaps in the esophagus, involving gastrostomy, TEF ligation, and constant drainage.

Thoracoscopic repair of EA/TEF, minimizing incisions and complications.

Using a colon segment or gastric tube to bridge a gap in the esophagus.

Infants with repaired esophagus should be fed in a semi-upright position to reduce the risk of regurgitation and aspiration.

Symptoms can include poor feeding, choking, difficulty swallowing (dysphagia), drooling, and regurgitating undigested food.

A potential complication after esophageal repair where the connection leaks.

Narrowing of the esophagus, causing difficulty swallowing.

Infants with EA/TEF may experience problems with thriving and weight gain, particularly in the first 5 years of life, especially if born preterm.

Problems with the esophagus's ability to move, leading to swallowing issues and breathing difficulties.

Monitor developmental milestones closely and seek early intervention services if any delays are observed.

A condition where stomach contents flow back up into the esophagus.

Parents need to learn signs of respiratory distress and esophageal stricture, and obtain necessary equipment and home nursing services.

High survival rate in healthy infants, but complications can occur in preterm babies and those with other anomalies.

Infants with excessive frothy saliva, difficulty with secretions, and unexplained episodes of apnea, cyanosis, or oxygen desaturation should be suspected of having Esophageal Atresia (EA) or Tracheoesophageal Fistula (TEF).

The initial concern for a newborn suspected of having EA/TEF is establishing a patent airway and preventing further respiratory distress.

The optimal position for a newborn suspected of having EA/TEF is supine (or sometimes prone) with the head elevated at least 30 degrees.

The mouth and nasopharynx are suctioned to facilitate drainage and avoid aspiration by promptly removing any secretions.

Immediately removing secretions to minimize aspiration is critical. A double lumen catheter, placed orally or nasally, continually keeps the blind pouch empty by intermittent or continuous suction.

Nursing interventions include respiratory assessment, airway management, thermoregulation, fluid and electrolyte management, and parenteral nutrition (PN) support.

Often, transfer to a hospital with a specialized care unit and pediatric surgical team is required.

The nurse needs to inform and support the parents about the infant's condition and provide necessary information.

Newborns after surgery need their body temperature carefully controlled to prevent complications.

Gradually introduce feedings by mouth after surgery, observing for tolerance and potential complications.

Even after minimally invasive surgery, infants need pain relief, just like adults.

Chest tubes and NG catheters are used to drain fluids and monitor complications.

Infants after surgery are at risk for lung problems like pneumonia and collapsed lungs.