PIPER (Retrieval Team) (Dr Scott) and Butterfly (Surgical NICU) (Mss Hawley and Brooks), Royal Children's Hospital, Melbourne, Australia.
Adv Neonatal Care. 2021 Feb 1;21(1):68-76. doi: 10.1097/ANC.0000000000000763.
Timely identification of esophageal atresia is challenging. Diagnosis may be suspected antenatally with a combination of polyhydramnios, associated with a small or absent stomach bubble or other anomalies. Esophageal atresia can be suspected postnatally in the presence of tachypnea, increased oral secretions, and an inability to advance an orogastric tube. Failure to recognize an esophageal atresia can have life-threatening implications.
A 5-day-old infant with a history of failure to thrive and respiratory distress presented in a community emergency department following a prolonged apnea associated with a breastfeed.
Delayed postnatal diagnosis of esophageal atresia and tracheoesophageal fistula.
During stabilization in the emergency department, a nasogastric tube was placed to decompress the stomach. A subsequent chest and abdominal radiograph identified the nasogastric tube curled in the upper esophagus, confirming an esophageal atresia. The abdominal radiograph demonstrated gaseous distension, suggesting the presence of a distal tracheoesophageal fistula.
The neonate had a primary esophageal anastomosis and fistula ligation in a surgical neonatal unit. He was discharged home at 29 days of life.
Understanding the challenges of an antenatal diagnosis and awareness of postnatal presentation with a view to improving postnatal recognition and better-quality outcomes for infants with an esophageal atresia and tracheoesophageal fistula.
及时识别食管闭锁具有挑战性。产前可能会出现羊水过多，同时胃泡较小或缺失，或存在其他异常，从而怀疑存在食管闭锁。也可能在出现呼吸急促、口腔分泌物增多和无法推进经口胃管时，怀疑存在食管闭锁。未能识别食管闭锁可能会产生危及生命的后果。
一名 5 天大的婴儿，存在生长迟缓史和呼吸窘迫，在社区急诊室就诊，此前曾因长时间呼吸暂停而接受母乳喂养。
食管闭锁和气管食管瘘的延迟产后诊断。
在急诊室稳定期间，放置了鼻胃管以排空胃部。随后的胸部和腹部 X 光片显示鼻胃管卷曲在上食管中，确认存在食管闭锁。腹部 X 光片显示气体膨胀，提示存在远端气管食管瘘。
新生儿在新生儿外科病房进行了原发性食管吻合术和瘘管结扎术。他在出生后 29 天出院回家。
了解产前诊断的挑战，并认识到出生后的表现，以提高对食管闭锁和气管食管瘘婴儿的产后识别能力，并改善其结局。
