Jan 1, 2009

A Baby with Tracheoesophageal fistula

One 1600 gm baby delivered 9 days back. It was full term normal delivery.Because of the low birth weight the baby was kept in the neonatal intensive care unit. After some time, nurse noticed lot of frothy secretions coming out from mouth of baby. She did suctioning of oral cavity and called the on duty doctor.The doctor noticed that there is continuous salivary secretions coming out from the mouth of the baby in spite of repeated suction. He then tried to put a nasogastric tube from one of the nasal cavity but the tube kept coming out of mouth.

I received the call from the NICU. When I took an x-ray, I noticed that there is coiling of nasogastric tube into the upper part of thorax. It did not reach the stomach. As I thought, it was a case of Tracheoesophageal fistula. The child underwent some more tests.

Now the main task was to disclose the diagnosis with parents immediately as such children needs an emergency operation.I called the father/close relatives in the cabin & told them condition of the child & that the baby needs an operation. As usual the first reaction was emotional shock through which they slowly recovered & gave consent for operation. I gave them a brief idea about the problem, the operation required, postoperative course etc. As it is major operation in a small baby, it is always better to discuss the success rate, possible postoperative complications, hospital stay & the cost involved.

In meantime anaesthetist examined the child & the baby shifted to operation room. In 2 hours baby was shifted back after undergoing an uneventful operation. He was kept on elective ventilation (respiratory machine) for 48 hours. After 48 hours the baby was started on feed through the orogastric tube.The water contrast dye study done at day 7 showed intact anastomosis without any leakage. baby was first put on test feeds & then shifted to breast feeds. Yesterday he was discharged from the NICU with smile on face of parents & a new year gift for them as well as for me. For more information on this problem click here.

Happy New Year to everybody!!!