A 3-day-old has choking, coughing and drooling of saliva, and a nasogastric tube will not pass. Diagnosis?

Oesophageal atresia (usually with a distal tracheo-oesophageal fistula). The classic triad is drooling, choking with feeds, and inability to pass a nasogastric tube beyond about 10-15 cm.

Clinical relevance. Early recognition prevents aspiration and triggers screening for associated VACTERL anomalies.

More Detail

Oesophageal atresia

Oesophageal atresia results from failure of the primitive foregut to separate cleanly into trachea and oesophagus, leaving a blind-ending upper pouch, commonly with a fistula between the trachea and the distal oesophagus.

Clinical features

• Drooling of saliva (classic) because secretions cannot be swallowed
• Choking, coughing, and cyanotic spells with feeds
• Respiratory distress and aspiration pneumonia
• Nasogastric tube arrests at 10-15 cm and may coil in the upper pouch on X-ray

Antenatal clues

• Maternal polyhydramnios (the fetus cannot swallow amniotic fluid)
• Small or absent fetal stomach bubble on ultrasound

Associations - VACTERL

Around half have other anomalies: Vertebral, Anorectal, Cardiac, Tracheo-, Esophageal, Renal, Limb. A 2D echocardiogram, renal ultrasound, and spinal X-ray screen for these.