Parents’ Post-Delivery Worry: An Incomplete Esophagus
One in 5000 babies are born with an incomplete esophagus making feeding impossible until corrected.
The amazing and usually seamless process of a child forming in the womb — it’s nothing short of a miracle! Two cells join and divide billions of times into different tissues to create a living, breathing human being with everything in the right place. But occasionally something does happen in this incredible chain of events, leading to the improper formation of an organ. And sometimes that organ can be the esophagus, the tube that carries nourishment from the baby’s mouth to his or her stomach.
This sounds terrifying, and indeed, it is a harrowing experience for parents struggling to understand why their baby cannot eat, breathe or stop vomiting during feeding. Esophageal atresia with tracheoesophageal fistula (or EA with TEF) occurs in about 1 out of every 5,000 births. Fortunately, this is something pediatric surgeons are trained to help correct and the rate of success is very high.
Here’s more about the condition and what it looks like inside the baby’s body:
The esophagus is a muscular tube that squeezes food and drink from the throat down to the stomach. It is positioned in the chest directly behind the trachea (or windpipe), which carries air to and from the lungs. Occasionally the esophagus, rather than being a single continuous tube, does not form properly and ends up being two separate segments. One segment connects to the throat and one to the stomach, but they do not connect to each other. This is known as esophageal atresia. In this condition, the infant is not able to eat since food cannot reach the stomach through this tube. Frequently, when this occurs, there is also an abnormal connection of one or even both segments of the esophagus to the nearby trachea. This abnormal connection is called a tracheoesophageal fistula. In this case, not only can the newborn not feed, but the connection (most frequently between the trachea and the lower segment of the esophagus connecting to the stomach) allows gastric fluids to reflux directly into the lungs. This can injure the newborn’s delicate lung tissue.
It is almost impossible to diagnose EA with TEF prenatally, and is usually discovered very soon after birth with symptoms of difficulty breathing, choking or vomiting during any attempt at feeding. When suspected, the malformation is diagnosed with an x-ray.
Once diagnosed, the patients are transferred to the Neonatal Intensive Care Unit and an urgent consult is made to a pediatric surgeon. Ultimately, the infant will have to have surgery to correct the abnormal esophagus. Should this ever happen to you or a loved one, the surgeon will guide and advise you through those decisions based upon what he or she sees during the physical exam and in reviewing the imaging studies. Not all EA with TEF patients are the same and the treatment plan can vary significantly.
It’s important to note that there are varying degrees of severity in EA with TEF, and many children do very well long-term. Occasionally some children will have problems with heartburn as they grow and develop. The esophagus, once connected, can sometimes still not function well, as muscles may have problems, or internal scarring may need to be corrected with additional surgery.
Esophageal atresia and tracheoesophageal fistula can be very scary, but with the right surgical team, you and your baby can have a very positive outcome.