Is your newborn having trouble swallowing milk? It could be Esophageal Atresia.

Does your newborn suddenly start coughing and choking when you give him some milk? Does he foam at the mouth? As a mother or father, you must be very scared when you see these things. Sometimes these symptoms can be caused by a congenital condition called Esophageal Atresia. Don't worry. Let's talk about this in simple terms today and understand everything.

Simply put, what is Esophageal Atresia (EA)?

Esophageal Atresia (pronounced "esophagus") is a birth defect. To be precise, it is a problem with the baby's esophagus. The tube that carries food from the mouth to the stomach when we swallow. The word "atresia" means that a passageway in the body is blocked or blocked. So, in the case of esophageal atresia, the baby's esophagus does not grow down from where it should connect to the stomach, but stops halfway and is blocked. It's like a water pipe that has broken in two. Because of this, the baby cannot drink milk or swallow food normally. Another serious problem that can be seen with this condition is tracheoesophageal fistula (TEF) . In this case, instead of connecting the esophagus to the stomach, it connects to the baby's trachea, which is the breathing tube. This is very dangerous, because things like milk and saliva that the baby swallows can go directly into the lungs.

Are there different types of this condition?

Yes, these Esophageal Atresia and Tracheoesophageal Fistula (TEF) conditions are divided into several main types depending on how they occur together or separately. Your doctor will plan your treatment based on the exact type.

How do you know if your baby has this condition? What are the symptoms?

Doctors and nurses pay close attention to these signs when examining a newborn baby. In particular, they pay attention to 3 main signs.

• Coughing: Especially when trying to drink some milk.
• Choking : Choking occurs because milk or saliva cannot be swallowed.
• Cyanosis: The skin and lips turn blue due to a lack of oxygen in the body.

These are those additional features:

• Foamy mucus discharge from the mouth.
• Excessive salivation.
• Vomiting or choking when trying to breastfeed.
• Difficulty breathing and rapid breathing .

Usually, other diseases that cause difficulty swallowing do not cause difficulty breathing. However, if both difficulty swallowing and difficulty breathing occur together , it is most likely due to a condition called Esophageal Atresia with Tracheoesophageal Fistula (TEF).

Why does this happen to babies? What is the main reason?

This is a congenital condition. That is, it happens while the baby is growing in the womb. Normally, in the early stages of the fetus, the esophagus and trachea are one tube. It is only later that this part separates into two parts, forming the esophagus and trachea. In the case of esophageal atresia , this separation process does not complete completely. Researchers have not yet been able to find out exactly what causes this process to stop halfway. But they believe that a combination of genetic and environmental factors may play a role.

How do doctors diagnose this disease?

Sometimes prenatal scans can provide clues, but most often the disease is diagnosed after the baby is born.

Prenatal Diagnosis

Sometimes clues about this can be seen during an anomaly scan, which is performed around 20 weeks of pregnancy.

• Polyhydramnios: If there is too much amniotic fluid around the baby. This is because the baby usually swallows this fluid. The fluid accumulates because the baby is unable to swallow.
• Small or invisible stomach bubble: If the baby's stomach is not filled with fluid during the scan .

If you see something like this, your doctor may recommend further testing, such as a fetal MRI.

After the baby is born (Postnatal Diagnosis)

Doctors suspect this condition when a baby shows the above symptoms at birth. The main test to confirm it is to try to insert a small tube (nasogastric tube) through the nose and into the stomach. If the esophagus is blocked, the tube stops halfway without going into the stomach. Then an X-ray is done to see exactly where the esophagus is blocked, whether it is connected to the trachea, and whether fluid has entered the lungs. If this disease is confirmed, doctors also check for other related birth defects.

Can this condition be completely cured with surgery?

Yes. In most cases, it is possible. Once the condition is diagnosed, the baby's condition is stabilized and the problem is resolved with surgery as soon as possible. However, some babies may need to stay in the hospital for a while before surgery.

• Until premature babies gain some weight.
• If the gap between the two parts of the esophagus is too large (Long-gap esophageal atresia - LGEA). In such cases, you will have to wait until the two parts grow a little and come closer.
• If there are other life-threatening problems, such as serious heart complications , those need to be treated first.

During this time, the baby receives all the necessary care under the supervision of specialist doctors and nurses in the Neonatal Intensive Care Unit (NICU) . The baby is given the necessary nutrition through a tube (enteral nutrition) or intravenously (parenteral nutrition). So you don't need to worry about the baby not being able to eat.

How are the treatments and surgery performed?

There are several main goals in treatment: stabilizing the baby's breathing, providing safe nutrition, and ultimately correcting the condition through surgery.

Instant management

Once the baby is diagnosed with this condition, the following things are done while preparing for surgery:

• Mucus and saliva that accumulate in the throat and mouth are removed by suction.
• A breathing tube is inserted to protect the airway.
• A feeding tube or IV line is used to provide nutrition and fluids.
• Antibiotics are given to prevent lung infections (pneumonia).

Surgery (Surgical Repair)

Once the medical team has determined that the baby is ready for surgery, the surgery is performed. The main goals are: 1. To reconnect the two separated parts of the esophagus (anastomosis). 2. To close a fistula (a connection between the esophagus and the windpipe), if one exists. Nowadays, whenever possible, surgeons perform this surgery using minimally invasive surgery . This means that instead of making a large incision in the chest, a camera (thoracoscope) and delicate instruments are inserted through several small incisions. This allows the baby to recover more quickly.

Recovery after surgery

After the surgery, the baby is taken back to the NICU. A few days later, a special X-ray called an esophagram is done to check if the incision has healed properly and if there is any leakage. Once everything is confirmed to be fine, the baby is gradually started to breastfeed under medical supervision. This takes some time for the baby to get used to.

What will the child's life be like after treatment?

Most children recover well and live normal lives. However, some children may develop long-term problems as a result of this condition and the surgery. These usually improve over time, but may require medical supervision for several years.

• Tracheomalacia: This is a condition in which the cartilage in the trachea becomes weak, causing the trachea to narrow slightly when breathing. This can cause wheezing , difficulty breathing during sleep, and frequent chest infections (pneumonia, bronchitis).
• Swallowing difficulties: Some children may have difficulty swallowing due to esophageal dysmotility. This problem can occur especially when introducing solid foods. This can be managed by cutting food into small pieces and giving it with liquids.
• Gastroesophageal Reflux Disease (GERD):This is when stomach acid comes up the esophagus (similar to gastritis). This condition occurs in about half of children treated with EA. It is imperative to treat this as directed by a doctor.

If your child has any of these difficulties, talk to your doctor about it regularly. You can seek the help of specialists such as speech-language pathologists and nutritionists to provide the support your child needs. Esophageal atresia, esophageal obstruction, tracheoesophageal fistula, birth defects, newborns, baby choking, neonatal surgery, esophagus