Management of the premature infant with esophageal atresia and hyaline membrane disease.

Prematurity of 34 weeks' gestation or less occurs in 12% of infants born with esophageal atresia and distal tracheoesophageal fistula, and is likely to result in moderate or severe hyaline membrane disease. In the past, these infants have often had their surgical treatment delayed or staged. Based on our experience of 24 such patients since 1977, we propose that optimal treatment involves early division of the distal tracheoesophageal fistula via a thoracotomy and simultaneous repair of the esophagus where the patient's condition permits. This should be in the first 12 hours of life, before the hyaline membrane disease becomes fully established. Gastrostomy is not required and may be contraindicated.