Esophageal atresia & TOF

[size=6]A four-month old boy with a history of prior esophageal atresia and tracheoesophageal fistula repair has undergone previous aortopexy when he presented with a brief resolved unexplained event (BRUE). Postoperatively, he continues to have significant episodes of BRUE and intermittent hypoxic spells. Persistent tracheomalacia is identified on radiographic and bronchoscopic evaluation. The next best step in management of this patient with BRUE episodes is a fundoplication. b tracheostomy. c tracheal stenting. d posterior tracheopexy. e repeat aortopexy.[/size]

[size=20px]An 8-month-old girl presents with choking with every feeding. She had a previous proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) repair at birth with an uneventful recovery although she is still taking antireflux medication. An esophagram shows minimal narrowing at the anastomosis but a smooth narrowing in the distal esophagus with contrast passing into the stomach. What is the most appropriate step in management? a increase proton pump inhibitor dose b esophagoscopy c laryngoscopy and bronchoscopy d balloon dilation e surgical resection[/size]

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[size=20px]While on call, you cover a community hospital 25 miles away. This hospital has a small NICU and pediatric ward. The neonatologists and hospitalists are the same group you work with at your children’s center. There are no additional pediatric specialists at this hospital. You are called in the middle of the night by an experienced neonatologist that a full-term, 3 kg baby girl was born and incidentally found to have a proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The patient had some respiratory distress and was just intubated. The baby is stable and now on minimal ventilatory settings. You inform the neonatologist that the most ap…

A 10 month old, former term infant boy with a history of long gap EA repair at another institution (done at the age of 4m after initial gastrostomy at birth) is on PPI for GERD. baby is complaining of infrequent attacks of Choking and regurgitation without weight loss and on upper GI study there is severe reflux but no stricture. baby sent to you by primary care physician for evaluation for fundoplication (as a second opinion after Primary surgeon is advising only using PPI). you advised doing fundoplication. The MOST compelling reason to stop the proton pump inhibitor and doing fundoplication[size=20px], as soon as reasonably possible, is due to the potential increased r…

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[size=20px]After performing an esophageal atresia repair the patient is doing well but an esophagram on postoperative day seven identifies an anastomotic leak adequately drained with a chest tube. Which of the following medications has been shown to slow or stop the esophageal leak? A metoclopramide / Reglan™ B esomeprazole / Nexium™ C guaifenesin / Mucinex™ D acetylcysteine / Mucomyst™ E glycopyrrolate / Robinul™ ​[/size]

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Six days after repair of esophageal atresia with distal tracheo-esophageal fistula in a baby boy born at term, this esophagogram is obtained.What do you see, and what will you do next?

A few hours old baby boy born at 26 weeks gestation, weighing 680 grams, is transferred to your center with a diagnosis of Esophageal Atresia. The baby underwent a difficult intubation immediately after birth and a nasogastric tube could not be passed into the stomach. On exam, the baby is hemodynamically stable and has no other obvious anomalies. The naso-esophageal tube has some scant blood. Two chest x-rays done two hours apart are shown. How do you proceed with management?

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