Typed] EA ual Proxima my Reece] OQ w'y. ed Ter. 2a ual a ik Vhtanen > dike Fee EM a > b- h J - r es + Of Cree, Type D- EA dere amd” Prowimak Tee. Saat : a Vi entibralh C... coloboma ie A norelal : jor deserts - ——__ Londra AL, Atema cheanaa ay Tlec R Ratarchod qfowk a E Bree exp inn eon ee TETAS R enat _& fan auemaliot SS fee cba ——— = s @ scanned with OKEN Scanner@ scanned with OKEN ScannerAIMS Protocols in Neone’'s""s” 208 Investigations + Inall cases: - Echocardiogram to look for cardiac anomalies and sidedness (must be pe; before surgery) ~ Renal ultrasound £ + Inselect cases’ - Infantogram, genetic studios ay, Stabilization + Nil per oral (NPO) + Head end elevation : ouch decompression (cidw intermitent suction via replogle fube/ suction catheter at 3-5 cm Hy ressure) = Keeping the neonate calm (to avoid swatiowing of ait) aortic ay ch formed Preoperative preparation + Broad-spectrum antibiotics? | + Vascular access: Umbilical lines | (UAC and UVC; if UVC is, malpositioned, manage with a joy. | lying UVC for the first 24-48 hours and switch to PIC line after sur + Parenteral nutrition « Urgent gastric decompression or TEF | | « Rigid bronchoscopy (performed ligation may be needed in difficult immediately before surgical repair) cases. may be considered” MI = = St 7] + Immediate primary repair is preferred and feasible in most cases (TEF division followed by primary anastomosis of the esophageal segments). It can be done via: <> Open approach (using right extrapleural thoracotom! s \O~ Thoracoscopic approach (in term neonates with normal pulmonary status): longer operative time but associated with shorter hospital stay, time to f ratory care including CPAP) * Wren required, low mean airway pressures (MAP) should be used + Rescue mode: High frequency ventilation (can be used with low MAP) gery) | extubation, and time to first + Long gap EA (any esophageal atresi intra-abdominal air or all other pes that tech ay requi Delayed primary repair (after Foker procedure, which involves lengthening of esophageal ends by placing them under traction with sutures for prolonged periods of up to 3 weeks) ~ Staged repair (usually in preterm neonates <1500 g; involves, ___-esophagostomy, gastrostomy and TEF division initially followed by late ___ éSophageal anasto Esophageal replacement (It it i d 1) not feasible) Serene in cage were prsmaty repel has tales aoe cae Acute postoperative care + Meticulous care of the trans-at arid eck meraroee ans-anastomolic feeding tube, endotracheal tube ET") + Elective venti ly marked for oraland ETT suctioning tive ventilation and i in anastomosis) Hon and paralysis for 2-7 days (individualised based on Tension !! 7 after si 7 n exoeasive nece fespiratory status (to minimize reintubations 2, Manipulation); may u: | ees se CPAP post- jon when necessa Cont rast s89phagogram on 5th-7th postoperalive iny (lor anastomotic eaks) a oral feeds and remove chest tube, a * Section 5 : 7 (cont) me fe por oa 2 He bet oval @ scanned with OKEN ScannerEeneocesophas > a Fistula jate complications ine mote leaks (15%): diagnosed on g * (apts) heal spontaneously; and are manage Geatum atibiotios ae ex existing chest tube q tures 40%) siagnose apy: treated by endoscopic ballodn si ophago enqoscoP align cltation nse eam a peat appiicat etalon. nasa | aces. «SF reouirence (6-10%): presentywith cho | —+eeaing, diagnosed by contrast eSophagogra Sis while | es managed with Surgical correct im and bronchoscopyrendascoy, reg managed WAN SUTGICT Corre Cth “ “Long-term complica : bag asrointestinal Dysphagia 80%), GERD {50% managed wih _” Sppression and iirtefracTory cases, with fundoplication), Bernie lati (gs) and esophageal cancer (1%); requires falow-up uth ences regi en aecbvonchomalese Cheats « airways: Fracheobronchomalacia (clinically significant gortopexy in 35%), vocal cord pened connec « Pulmonary (20-30%): Infections, asthma, bronchiectasis, restrictive lung disease. a = Chest wall deformities: Scoliosis, shoulder girdle muscle weakness, + Growth and development: Poor growth, delayed psychomotor development, (but lack of iong-term data on these outcomes). Fig. 19.3: Management algorithm of a neonate born with EA/TEF A: Esophageal atresia; GERD: gastroesophageal reflux disease; TEF: Tracheoe sophageal fistula) "Additional investigations may be required in presence of findings suggestive of syndromic associations like VACTERL, CHARGE, trisomy 21 or 18, etc. "Preoperative antibiotics are indicated if there is suspicion of aspiration pneumoni3 oF risk factors for early onset sepsis. 2Pre-tepair bronchoscopy jg. useful adjunct to confirm the diagnosis gan Mere to assess any associated tracheobronchomalacia or aditional THs, <" Positioning ofa Fogarty catheter to occlude the fistula. ' le-sided approach must be taken in the presence ¢ @*tapleural approach helps prevent a pleural empyem an ci Post-extubation CPAP in operated EA/TEF cases has not beena "sk of anastomotic leak or fistula recurrence PROGNOSIS ystems t© prognosticate Several groups have devised stratification open bith re eonates with EA/TEE. Most of thes al Weight and the presence of critical cardiac cts have the poorest itth weight <1.5-2 kg and Major ME However, Survival among neonates with EA/TEF. improved significantly (up ‘echniques and neonatal care- i arch. The vf a right-sided aortic a rcl aE astomotic leak develops iated with an increase’ @ scanned with OKEN Scanner