Morning Report

February

HPI
37 1/7 week infant born to a 25 yo G2P1001 via repeat C/S Maternal labs normal Prenatal U/S w/ no abnormality noted Good prenatal care APGARs of 8 (color and tone), 9 (color) Resuscitation included WDS only No abnormal family history

Physical exam
VS: WNL No abnormalities noted on physical exam

Further HPI
Taken to nursery to transition Weight, OFC, and height 50th percentile for During transition, started having episodes of apnea w/ desaturations, but no bradycardia Required BBO2 to help resolve these episodes

Differential Dx
Hypoxemia Anemia Infection (sepsis) Metabolic d/o Hyperthermia (secondary to warmer) Antepartum maternal administration of Mag Sulfate or Opiates Administration of opiates or anesthesia to infant Neurological d/o (intracranial hemorrhage, encephalopathy) NEC Congenital anomalies of airway Seizures

More of the story

Nurse tried to pass NG tube and it came out of the mouth Second attempt did not result in the NG coming out of the mouth and nurse felt she was able to pass it Patient went apneic w/ NG in place and tube was removed CXR was normal Transferred to the NICU NG replaced and CXR showed..

Esophageal Atresia +/- TEF

1in 3500 births Defect in lateral septation of the foregut into the esophagus and trachea Polyhydramnios in 2/3 of pregnancies Associated w/ VACTERAL Notable excessive secretions after birth Drooling, choking, apnea, and inability to feed Gastric distension on KUB

EA and TEF

Esophageal atresia +/- TEF

Gastric distension noted if fistula b/n trachea & espophagus Aspiration PNA can occur 2/2 reflux through fistula into lungs Usually picked up 2/2 choking and coughing w/ feeds

Making the diagnosis

Attempt passing NG
If cannot get past 10-15 cm, leave NG in place and obtain CXR

Isolated TEF is harder to pick up

Need Upper GI series

Bronchoscopy and Endoscopy is gold standard 3D CT scan more expensive than a CXR

EA and TEF
Treatment
Surgery

Outcome
Generally good Mortality generally associated w/ associated anomalies (chromosomal abnormality or cardiac defect)

Prognosis
Birth weight Gap length

Complications
Anastomotic leak (16%), esophageal stricture (35%), recurrent fistula (3%) Motility d/o and respiratory function abnormalities Increased risk of Esophageal Cancer