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Basic Knowledge of Tracheoesophageal Fistula and Esophageal Atresia

Lee, Sura MSN, CRNP

Section Editor(s): Meeker, Tamara M.

doi: 10.1097/ANC.0000000000000464
Special Series: Surgical Issues
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Background: Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity.

Purpose: Timely management of the neonate can greatly impact the infant's overall outcome. Spreading latest evidence-based knowledge and sharing practical experience with clinicians across various levels of the neonatal intensive care unit and well-baby units have the potential to decrease the rate of morbidity and mortality.

Methods/Search Strategy: PubMed, CINAHL, Cochrane Review, and Google Scholar were used to search key words— tracheoesophageal fistula, esophageal atresia, TEF/EA, VACTERL, long gap, post-operative management, NICU, pediatric surgery—for articles that were relevant and current.

Findings/Results: Advancements in both technology and medicine have helped identify and decrease postsurgical complications. More understanding and clarity are needed to manage acid suppression and its effects in a timely way.

Implications for Practice: Knowing the clinical signs of potential TEF/EA, clinicians can initiate preoperative management and expedite transfer to a hospital with pediatric surgeons who are experts in TEF/EA management to prevent long-term morbidity.

Implications for Research: Various methods of perioperative management exist, and future studies should look into standardizing perioperative care. Other areas of research should include acid suppression recommendation, reducing long-term morbidity seen in patients with TEF/EA, postoperative complications, and how we can safely and effectively decrease the length of time to surgery for long-gap atresia in neonates.

Newborn/Infant Intensive Care Unit, Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Correspondence: Sura Lee, MSN, CRNP, Newborn/Infant Intensive Care Unit, Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (leesura@email.chop.edu).

The author declares no conflict of interest.

© 2018 by The National Association of Neonatal Nurses