What is oesophageal atresia (OA)?
In a baby with oesophageal atresia (OA) the swallowing tube (oesophagus) fails to develop properly. The upper part of the oesophagus is completely blocked and the baby is unable to swallow. The baby will choke if feeding is attempted. In most cases, the lower part of oesophagus is connected to the windpipe (trachea); this connection is known as a tracheo-oesophageal fistula (TOF). OA affects about 1 in 3000 births.
How do you know if my baby has OA?
Because baby cannot swallow properly, OA is sometimes first detected on an antenatal ultrasound scan if the baby is found to have a small stomach and there is excess amniotic fluid (polyhydramnios) around the baby. In many cases, OA is not detected until after birth when the baby has excessive saliva from the mouth along with some choking from being unable to swallow secretions. If a nurse tries to pass a thin plastic tube (nasogastric tube) into the stomach, the tube will not reach the stomach. An X-ray then confirms the diagnosis.
Where should I have my baby?
If OA has been suspected antenatally, your baby will be delivered in a specialised hospital , where specialist medical and surgical help are available.
What will happen after birth?
Your baby will be admitted to the neonatal intensive care unit and cared for by the doctors and nurses there.
An X-ray will be taken after attempting to pass a nasogastric tube into your child’s stomach. The X-ray will confirm the diagnosis. A special suction tube is usually
passed into the upper oesophagus to keep it clear of secretions. Your baby will receive fluids and glucose via a drip and antibiotics may be given.Up to 50% of babies with OA can have another congenital abnormality and so baby will need a thorough clinical examination. A heart scan will also be carried out. Within the first week, other scans and X-rays will be done to check the baby’s kidneys and spine.
Will surgery be needed?
Surgery is needed to repair the blocked oesophagus. This is usually carried out within 48 hours of birth. Sometimes the surgery is urgent, particularly if the baby needs to be on a breathing machine (ventilator).
The type of surgery depends on the exact type of oesophageal blockage (which can vary). In the commonest form of OA, which affects about 85% of babies, the lower oesophagus needs to be disconnected from the windpipe and joined to the upper oesophagus. In some cases, the two ends of the swallowing tube are too far apart and cannot be brought together; these babies will require an operation to put a temporary feeding tube into the stomach (a gastrostomy) and a month or two later when baby has grown an attempt is made to join the two ends of the oesophagus together. The baby needs to stay in hospital during this time and the upper oesophagus must be permanently suctioned to avoid secretions collecting in the mouth. If your baby has a rarer type of OA the surgery will be different but this will be explained.
What happens after surgery?
Your baby will return from surgery on a ventilator. He/she will receive painkillers such as morphine and paracetamol. Feeds are often started 2-3 days after surgery – this may be through a nasogastric tube or by mouth. In cases where the repair has been difficult, feeds may be withheld for up to a week but throughout this time baby will receive nutrition and fluids through a vein (called parenteral nutrition). Occasionally, a special X-ray dye test is done to check the join in the oesophagus.
What problems could occur after surgery?
Some babies develop a leak at the join in the oesophagus; most leaks heal up by themselves without the need for more surgery but a temporary tube (chest drain) may need to be put into the chest to drain away any air or fluid from the leak.
Many babies develop a narrowing (called a stricture) at the site of the join in the oesophagus. This can be stretched with a balloon under a general anaesthetic(oesophageal dilatation) to help baby swallow better. This procedure is done with a flexible telescope inserted through the mouth. Some babies require several dilatations before the narrowing is completely better.
Most babies with OA have significant gastro-oesophageal reflux because the valve at the bottom end of the oesophagus where it joins the stomach is weak. As a result, milk comes back up the swallowing tube after feeds causing small vomits. This is treated with medicines and by adjusting the feeds but some babies develop severe reflux, which requires further surgery to tighten the valve at the bottom end of the oesophagus.
even after a successful oesophageal repair, the oesophagus doesn’t work absolutely normally. Some babies require temporary feeding through a nasogastric tube or gastrostomy until their swallowing improves. Older children with OA are encouraged to chew their food well and take fluids with their meals to wash the food down.
This is the medical name for a floppy windpipe which is present in most babies with OA. This is not usually a severe problem but occasionally it causes difficulties with breathing and rarely an operation is required to improve the airway. The windpipe becomes stronger as the baby grows but children with OA typically have a loud cough (a “TOF cough”) from the floppy windpipe. What should we expect in the longer term?
How long will my baby stay in hospital?
After a straightforward repair of the common type of abnormality (85%) babies are able to go home within 2-3 weks once they are feeding well and gaining weight. Babies with more complex types of OA need to be in hospital for longer.
What happens after discharge home?
The neonatal team will see your baby in out-patients to review their feeding, growth, development and any other medical conditions that they may have. You will also need to be seen in the paediatric surgery clinic. Older children are seen once every year or two until puberty.