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Course: Pediatric Nursing

Topic: Nursing Care of Child with

Esophageal Atresia/ Tracheoesophageal Fistula

"The Nurses International Community"

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Module Goals

Learners will be able to:

Define esophageal atresia.
Describe different types of esophageal atresia.
Discuss sign and symptoms of esophageal atresia.
Identify the causes of esophageal atresia.
Describe the common diagnostic procedures.
Describe management of a child with esophageal atresia.
Discuss the nursing management for esophageal atresia.

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Esophageal Atresia

NHS, 2021

A rare birth defect that affects an infant’s esophagus.

The upper part of the esophagus doesn't connect with the lower esophagus and stomach and usually ends in a pouch.

Often happens along with another birth defect called a tracheoesophageal fistula.

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Tracheoesophageal Fistula

NHS, 2021

A connection between the lower part of the oesophagus and the windpipe (trachea).

Causes air to pass from the windpipe to the esophagus and stomach, and stomach acid to pass into the lungs.

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Esophageal Atresia: Types

CDC, 2021

Cochran, 2021

Five major types:

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Esophageal Atresia: Types

Type A:

The upper and lower parts of the esophagus do not connect and have closed ends.
No parts of the esophagus attach to the trachea.

Type B:

Very rare.
The upper part of the esophagus is attached to the trachea, but the lower part of the esophagus has a closed end.

CDC, 2020

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Esophageal Atresia: Types

CDC, 2020

Type C:

The most common type
The upper part of the esophagus has a closed end and the lower part of the esophagus is attached to the trachea

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Esophageal Atresia: Types

Type D:

The rarest and most severe
The upper and lower parts of the esophagus are not connected to each other, but each is connected separately to the trachea

Type E: (H type)

TEF without esophageal atresia
Infants with the H type fistula may not present until later in life

CDC, 2020

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Critical Thinking Question

Which type of esophageal atresia is most common in infants?

Type A
Type B
Type C
Type D

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Esophageal Atresia: Causes

In most infants causes are unknown.
Thought to be caused by a problem with the development of the oesophagus while the baby is in the womb.
Common in infants of mothers who had excess amniotic fluid in pregnancy (polyhydramnios).

CDC, 2020

NHS, 2O21

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Esophageal Atresia: Sign and Symptoms

Cyanosis, often with attempted feeding
Coughing, gagging, and choking with attempted feeding
Excessive secretions/ Drooling or Vomiting
Poor feeding
Aspiration pneumonia
Abdominal distention with distal fistula

Medlineplus, 2021

Cochran, 2021

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Case Study

A newborn who presents with which of the following symptoms may have Esophageal Atresia with a Tracheoesophageal Fistula?

An infant who is drooling and cyanotic after feeding
A infant who has a temperature of 100.9 and high heart and respiratory rates
An infant who was born at 34 weeks gestation and has low blood sugar

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Esophageal Atresia: Sign and Symptoms

Two syndromes are particularly associated:

VACTERL (vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, esophageal atresia, renal anomalies and radial aplasia, and limb anomalies)
CHARGE (coloboma, heart defects, atresia of the choanae, retardation of mental and/or physical development, genital hypoplasia, and ear abnormalities)

About 19% of infants with esophageal atresia meet criteria for VACTERL

CDC, 2021

Cochran, 2021

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Esophageal Atresia: Diagnosis

Prenatal:

Rarely diagnosed during pregnancy

Postnatal:

Most commonly detected after birth when the baby first tries to feed and has choking or vomiting.
When a tube inserted in the baby’s nose or mouth cannot pass down into the stomach.

An x-ray can confirm that the tube stops in the upper esophagus.

CDC, 2020

Medlineplus, 2021

Cochran, 2021

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Critical Thinking Question

Esophageal atresia is usually diagnosed during pregnancy.

True
False

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Esophageal Atresia: Treatment

Surgical Repair
Before and after surgery, the baby is fed either:

Through a gastrostomy tube (G-tube) so that the baby can be fed directly into the stomach
Nutrition given through the veins

CDC, 2020

Medlineplus, 2021

Cochran, 2021

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Esophageal Atresia: Preoperative Management

Aims to prevent aspiration:

Oral feedings are withheld
Continuous suction in the upper esophageal pouch prevents aspiration saliva
Position an infant prone with the head elevated 30 to 40° and with the right side down to facilitate gastric emptying and minimize the risk of aspirating gastric acid through the fistula
A gastrostomy tube to decompress the stomach

Suction through the gastrostomy tube reduces the risk that gastric contents will reflux through the fistula into the tracheobronchial tree

Cochran, 2021

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Nursing Management

Ensure safe swallowing:

Suction as needed
Ensure proper nutrition through enteral feedings

Prevent aspiration:

Check placement before feeding
Elevate the head of bed to 30 to 45 degrees while feeding the child and for 30 to 45 minutes afterward if feeding

Health teaching
Psychological support

Cochran, 2021

Belleza, 2021

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What would a nurse do?

Which nursing interventions are appropriate prior to surgery with an infant with tracheoesophageal fistula? (Select all that apply)

Use continuous suctioning
Continue feeding
Maintain supine position
Maintain NPO

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Red Flags

Cyanosis, often with attempted feeding
Excessive secretion
Nasogastric tube can not be enter down to the stomach

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

CDC (a). (2020). Facts about Esophageal Atresia. https://www.cdc.gov/ncbddd/birthdefects/esophagealatresia.html#:~:text=Esophageal%20atresia%20is%20a%20birth,the%20mouth%20to%20the%20stomach

CDC (b). ( March 30. 2021). Congen Anom of the Dig Sys: Oesophageal Atresia/Tracheo-Oesophageal Fistula. https://www.cdc.gov/ncbddd/birthdefects/surveillancemanual/quick-reference-handbook/oesophageal-atresia-tracheo-fesophageal-fistula.html

Cochran, W. J. (2021). Esophageal Atresia. MSD Manual. https://www.msdmanuals.com/professional/pediatrics/congenital-gastrointestinal-anomalies/esophageal-atresia

NHS. (25 August 2021). Oesophageal atresia and tracheo-oesophageal fistula. https://www.nhs.uk/conditions/oesophageal-atresia/

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