The document discusses tracheoesophageal fistula (TEF), which is an abnormal connection between the trachea and esophagus present from birth. It classifies TEF into 5 types based on the location of the fistula. Signs include excessive drooling and difficulty feeding. Diagnosis involves imaging and inability to pass a feeding tube. Treatment involves surgery to ligate the fistula and reconnect the esophagus. Nursing care focuses on preventing aspiration, supportive care, and parental education on postoperative care and feeding.

1. MUHIMBILI UNIVERSITY OF
HEALTH AND ALLIED SCIENCES.
SCHOOL OF NURSING.
DERPARTMENT OF CLINICAL NURSING
PEDIATRIC NURSING( PD300)
PRESENTATION:TOPIC - TRACHEO ESOPHAGEAL FISTULA
PRESENTER:JOHN, Songoma .Reg NO 2009-04-01476
SUPERVISOR :MR. MENTI NDILE

2. INTRODUCTION
• Esophageal atresia (EA) is the congenital malformation that
represent the failure of the esophagus to develop a
continuous passage up to the stomach
• Tracheo esophageal fistula (TEF) is the congenital
malformation where the trachea and esophagus fails to
separate into distinct structures and a passage is created
between the two.
• Tracheoesophageal defect is a serious, congenital condition in
which there is an abnormal connection between the trachea
and the esophagus; the esophagus ends before reaching the
stomach and/or the esophagus develops as a pouch
connected to the trachea by a fistula.

3. Esophagus : tube that connects the mouth to
the stomach
Trachea: "windpipe“
Atresia : absence of a normal opening
Congenital : found at birth.
Fistula : abnormal passage from a body organ to
the body surface or between two internal
body organs.

5. CLASSIFICATION OF TEF
• Classified by American Academy of Pediatrics as
• TYPE A : It consists of blind upper and blind lower esophageal
segment without any tracheo- esophageal fistula (3.7 to 7%).
• TYPE B : It involves fistula from trachea to upper oesophageal
segment (0.8%).
• TYPE C: It type in which proximal esophageal segment
terminates in a blind pouch and the distal esophageal segment
is connected to trachea or primary bronchi by a short fistula at
or near tracheal bifurcation (86%).
• TYPE D : It involves fistula from trachea to both upper and
lower esophageal segments (0.7 to 6%).
• TYPE E : It refers to H type TEF which are having otherwise
normal trachea and oesophagus that are connected by a fistula
(4.4- 7%)

6. TYPES

7. INCIDENCE & EPIDEMIOLOGY
• Occurs in 1:3000 to 1:4500 live births. Equal gender
incidence EA associated with prematurity. A history
of maternal polyhydroamnios is present in approx.
50% of infants with the defects. Often present with
VATER/VACTERL syndromes. (VATER/VACTERL is
acronyms that describe the associated anomalies of
vertebral, ano-rectal, cardiovascular, tracheo-
esophageal, and renal and limb abnormalities).
Possible influences Inherent genetic factor ,
teratogens Environment factor Prematurity & low
birth weight.

8. PATHOPHYSIOLOGY
• Upper part of esophagus is developed from
retropharyngeal segment and the lower part from
pregastric segment of the first part of primitive gut.
At 4- 5weeks of gestation the laryngo-tracheal
groove is formed. Two longitudinal furrows develop
and separate the respiratory premordium from
esophagus. Deviation or altered cellular growth of
the septum results in formation of fistula between
esophagus and trachea. Successive stages in the
development of the tracheoesophageal septum
durin g embryologic development.

9. Causes
• Congenital TEF can arise due to failed fusion
of the tracheoesophageal ridges during the
third week of embryological development.TEF
can also occur due to pressure necrosis by a
tracheostomy tube in apposition to a
nasogastric tube (NGT).

10. Environmental (Acquired) Causes
• Although exposure to certain medications and
infections during pregnancy have been
proposed as possible risk factors for
development of esophageal
atresia/tracheoesophageal fistula (EA/TEF), no
external factor has been consistently linked to
the development of EA/TEF
• Exposure to methimazole during pregnancy .
• Maternal diabetes mellitus .

11. Heritable Causes
• Chromosome anomalies have been reported
in approximately 6%-10% of individuals with
EA/TEF . EA/TEF is found in the following
aneuploidy syndromes :
• Trisomy 21 (~0.5%-1.0% of affected
individuals)
• Trisomy 18 (~25% of affected individuals)
• Trisomy 13
• (Mosaic) trisomy X

12. Signs and Symptoms
• Excessive oral secretions
• Constant drooling or Excessive salivation.
• Intolerance of feedings
• Regurgitation of feedings
• Periodic episodes of choking and cyanosis
• When fed, infant swallows but coughs, gags, and
returns feeding through the nose and mouth
• Respiratory distress from aspiration of secretions
• Abdominal distention occurring soon after birth
when air from the trachea enters esophagus and
stomach through the fistula

13. Diagnosis
EA/TEF may be suspected prenatally if
• ultrasound examination reveals polyhydramnios, absence of a
fluid-filled stomach, a small abdomen, lower-than-expected
fetal weight, and a distended esophageal pouch
• Fetal MRI may be used to confirm the presence of EA/TEF
TEF may be detected postnatally by
• X-ray taken with radiopaque catheter placed in esophagus to
check for obstruction; standard chest X- ray shows a dilated air-
filled upper esophageal pouch and can demonstrate
pneumonia
• inability to pass a NG tube into stomach because it meets
resistance; required
• bronchoscopy visualizes fistula between trachea and
esophagus; abdominal ultrasound;
• and an echocardiogram to check for cardiac abnormalities.

14. Treatment of Manifestations
• Initial postnatal intervention, aimed at minimizing
the risk of aspiration pneumonia, typically includes
the elimination of oral feeds, placement of a suction
catheter to allow continuous drainage of secretions,
and elevation of the head of the bed to minimize
reflux .
• Intravenous (IV) glucose and fluids should be
provided; supplemental oxygen should be
administered as needed.
• When intubation cannot be avoided, a possible
complication is the collection of air in the stomach,
which in severe cases can only be removed by
gastrostomy

15. Treatment of Manifestations
• Surgical repair consists of closure of the TEF and anastomosis
of the esophageal segments .
• Surgical repair may need to be delayed in infants with low
birth weight, pneumonia, or other major congenital
anomalies.
• When surgical repair is delayed, infants may be treated with
parenteral nutrition, gastrostomy tube placement, and upper
pouch suctioning until they become surgical candidates.
• The most common complications after surgical repair include
leakage at the site of the anastomosis, recurrent fistula,
structure formation, and gastroesophageal reflux

16. Treatment of Manifestations
Surgery:
• Usually an emergency, is performed as soon as
infant is stable.
• Involves ligation of fistulas and anastamosis of
esophagus to stomach.
• Completed in one procedure if possible or done
as a staged repair. Supportive care until surgery;
IV antibiotics; GT inserted before surgery to
decompress stomach.

17. NURSING MANAGEMENT.
• Assess for symptoms immediately after birth
• Assess patency of esophagus before feeding or
putting to breast
• Evaluate difficulty feeding, respiratory distress, excess
drooling, choking, and coughing
• Assess lung sounds
• Use semi-Fowler’s position to prevent reflux of gastric
contents into trachea and to ease respiratory effort
• Monitor respiratory status closely
• Prevent aspiration
• Maintain fluid and electrolyte balance

18. NURSING MANAGEMENT
• Administer IV fluids to prevent dehydration
• Provide emotional support and reassurance to parents
• Encourage parents to spend as much time with infant as
possible
• Place in warm, humidified environment
• The infant is immediately deprived of oral intake (NPO) Start
IV fluids.
• Removal of secretions from the mouth and upper pouch
requires frequent or continuous suction with Replogle’s
catheter every 5 min gently with pressure of 50 cm of H₂O.
• Broad spectrum antibiotic therapy is often instituted.

19. CLIENT TEACHING FOR SELF-CARE
• Involve parents in care of infant to facilitate
bonding by means of touch and eye contact
• Offer information to parents about the
defect, surgical repair, pre- and postoperative
care and prognosis, and need for possible
further surgery
• Teach parents how to administer
gastrostomy feedings until esophagus heals

20. COMPLICATIONS
• Tracheomalacia (weakness of tracheal
wall) Anastomotic leak (tension)
Strictures (narrowing, esophageal
dilation) Dysphagia (esophageal motility
disorder) Respiratory distress
Gastroesophageal reflux (positioning,
semisolids, fundoplication).

21. reference
• www.cincinnatichildrens.org/health/info/ent/diagnose/trach-
fistular.htm
• Boxwell, G. (Ed), (2000). Neonatal intensive care nursing.
London: Routledge; Chapter 15, Surgical Aspects; pp 347 - 352
• Chambers MA, & Jones, S. (eds).2007. Surgical nursing of
children, Edinburgh: Butterworth Heinemann Elsevier, Chapter
9, Neonatal Nursing.
• Ghai OP, Paul K Paul, Bagga Arvind. Essential Pediatrics . CBS
publishers. 17 th edition. Pp 151 Meharban singh . Care of
newborn. 6 th edition. Sagar publications. Pp 138 Marilyn J.
Hockenberry , Wilson, Essentials of Pediatric Nursing, Elsevier,
8 th edition. 465-473.
• www. Wikipedia . Com/ tracheoesophageal atresia/