3. INCIDENCE
• It occur in 1 in 3,500 births,
• Slight male dominance.
• Prematurity is common with associated TEF, with 34% of
these infants weighing less than 2500 gm.
4. Conti..
• Approximately 50% of neonates with TEF have other
anomalies
• Cardiac anomalies is the most common (14.7% to 28%)
and life-threatening.
• Associated anomalies include defects of the vertebrae,
anorectal malformations, cardiac defects, renal defects.
6. Conti…
• Cause unknown in most cases. Possible influences include:
– Inheritable genetic factor;
– Twin babies
– Siblings
– Offspring of affected adults
– Teratogenic stimuli
– Environmental factors
– Heredity
– Genetic factors
7. Conti…
• Failure of proper separation of the embryonic
channel into the esophagus and trachea
occurring during the fourth and fifth weeks of
gestation.
9. Conti..
– Type I (Type A):
Proximal and distal
segments of esophagus
are blind; there is no
connection to trachea;
accounts for 8% of cases;
second most common.
TRACHEA
ESOPHAGUS
11. Conti..
Type II (Type B):
proximal segment of
esophagus opens into
trachea by a fistula;
distal segment is
blind; rare, 3% of
cases.
TRACHEA
ESOPHAGUS
FISTULA
13. Conti..
• Type III (Type C): proximal
segment of esophagus has
blind end; distal segment of
esophagus connects into
trachea by a fistula; most
common, with 85% of
cases
TRACHEA
ESOPHAGUS
FISTULA
15. Conti..
– Type IV (Type D): esophageal atresia with
fistula between proximal and distal ends of
trachea and esophagus; (rare 1% of cases).
17. Conti..
– Type V (Type E): proximal and distal segments of
esophagus open into trachea by a fistula; no esophageal
atresia but sometimes referred to as an H-type fistula;
occurs in 4.4% to 7% of cases, not usually diagnosed at
birth.
20. PATHOPHYSIOLOGY
The baby with TEF is unable to swallow effectively which result
in accumulation of saliva or feed in upper esophageal pouch and
aspiration in respiratory passage.
Gastric secretion may regurgitate through distal fistula.
Abdominal distension may occur due to air entering the lower
esophagus through the fistula and passing into the stomach
during crying.
respiratory distress may develop due to gastric distension and
elevation of the diaphragm
21. CLINICAL MANIFESTATIONS
• 3 cardinal signs – cough, choking and
cyanosis
• Excessive secretions
• Intermittent unexplained cyanosis
• Laryngospasm
• Abdominal distention
• Violent response of baby
• Poor feeding
• Inability to pass catheter through nose or mouth into stomach
22. DIAGNOSTIC EVALUATION
• Assessment
• Ultrasound scanning techniques
• X-ray of abdomen and chest
• Barium x-ray
• Electrocardiogram and
• Echocardiogram
23. MANAGEMENT
• IMMEDIATE TREATMENT
• Propping infant at 30-degree angle to prevent reflux of gastric
contents.
• Gastrostomy to decompress stomach and prevent aspiration
• Nil per oral (NPO)
• I.V. fluids
25. SURGERY
• Prompt primary repair (anastomosis)
Anastomosis- a connection made
surgically between adjacent blood vessels,
parts of the intestine, or other channels of
the body.
27. • Gastrostomy
A gastrostomy is a surgical procedure used to
insert a tube, often referred to as a "G-tube",
through the abdomen and into the
stomach. Gastrostomy is used to provide a
route for tube feeding if needed for four
weeks or longer, and/or to vent the stomach
for air or drainage.
28. • Cervical esophagotomy
• Circular esophagomyotomy
Esophagomyotomy involves splitting the
muscular layers of the distal esophagus and
proximal stomach while leaving the mucosa
intact.
29. NURSING ASSESSMENT
Preoperative Nursing Diagnoses
1)Nursing Diagnoses: Risk for Aspiration
related to structural abnormality
• Expected outcome: Preventing Aspiration
• Intervention
30. Nursing Interventions
• Position the infant with head and chest elevated 20 to 30
degrees to prevent or decrease reflux of gastric juices into the
tracheobronchial tree.
– This position may also ease respiratory effort by dropping the
distended intestines away from the diaphragm.
– Prone position will allow gastric juices to pool anteriorly
away from the esophagus.
– Turn frequently to prevent atelectasis and pneumonia
31. Nursing Interventions
• Maintain the infant's temperature in thermoneutral zone, and
ensure environmental isolation to prevent infection by using
Isolation.
• Administer oxygen as needed.
• Suction mouth to keep clear of secretions and prevent
aspiration. Provide mouth care.
32. Nursing Interventions
• Be alert for indications of respiratory distress.
– Retractions
– Circumoral cyanosis
– Restlessness
– Nasal flaring
– Increased respiration and heart rate
• Maintain NPO status.
• Administer antibiotics as ordered to prevent or treat
associated pneumonitis.
34. Nursing Interventions
• Observe infant carefully for any change in condition;
report changes immediately.
– Check vital signs, color and amount of secretions,
abdominal distention, and respiratory distress.
– Evaluate for complications that can occur in any
neonate or premature infant.
• Be available, and recognize need for emergency care
or resuscitation.
– Have resuscitation equipment on hand.
35. Nursing Interventions
• Monitor for signs or symptoms that may indicate
additional congenital anomalies or complications.
• Gastrostomy tube may be placed before definitive surgery
to aid in gastric decompression and prevention of reflux.
• Maintain gastrostomy tube to straight gravity drainage,
and do not irrigate before surgery.
36. 2)Nursing Diagnoses: Risk for Deficient Fluid
Volume related to inability to take oral fluids
• Expected outcome: Preventing Dehydration
• Intervention
37. Nursing Interventions
• Administer parenteral fluids and electrolytes as
prescribed.
• Monitor vital signs frequently for changes in blood
pressure (BP) and pulse, which may indicate dehydration
or fluid volume overload.
• Record intake and output, including gastric drainage (if
gastrostomy tube for decompression is present) and weight
of diapers.
• Checked weight daily.
38. • 3)Nursing Diagnoses: Anxiety of parents
related to critical situation of neonate
• Expected outcome: Reducing Parental
Anxiety
• Intervention
39. Nursing Interventions
• Explain procedures and necessary events to parents as soon
as possible.
• Orient parents to hospital and intensive care nursery
environment.
• Allow family to hold and assist in caring for infant.
• Offer reassurance and encouragement to family frequently.
Provide for additional support by social worker, and
counselor as needed.
41. Nursing Interventions
• Keep endotracheal (ET) tube patent by frequent lavage and
suction. Note: Reintubation could damage the anastomosis.
• Suction frequently; every 5 to 10 minutes may be necessary,
but at least every 1 to 2 hours.
• Observe for signs of obstructed airway. Ventilatory support
is continued until clinically stable (usually 24 to 48 hours)
42. Nursing Interventions
• Request that the surgeon mark a suction catheter,
indicating how far the catheter can be safely inserted
without disturbing the anastomosis (usually 1 inch [2 to 3
cm]).
• Administer chest physiotherapy as prescribed.
– Change the infant's position by turning; stimulate crying to
promote full expansion of lungs.
– Elevate head and shoulders 20 to 30 degrees.
– Use mechanical vibrator 2 to 3 days postoperatively (to
minimize trauma to anastomosis), followed by more
vigorous physical therapy after the 3rd day.
• Continue use of Isolette or radiant warmer with humidity
43. 2) Nursing Diagnoses: Ineffective Infant
Feeding Pattern related to defect
• Expected outcome: providing adequate
nutrition
• Intervention
44. 3) Nursing Diagnoses : Acute Pain related to
surgical procedure
• Expected outcome: Providing Comfort
Measures
• Intervention
45. 4) Nursing Diagnoses: Impaired Tissue
Integrity related to postoperative drainage
• Expected outcome: Maintaining Chest
Drainage
• Intervention
46. 5) Nursing Diagnoses: Risk for Injury related to
complex surgery
• Expected outcome: Observing for
Complications
• Intervention
47. 6) Nursing Diagnoses: Risk for Impaired
Parent/Infant Attachment related to prolonged
hospitalization
• Expected outcome: Stimulating Parent-Infant
Attachment
• Intervention
![Nursing Interventions
• Request that the surgeon mark a suction catheter,
indicating how far the catheter can be safely inserted
without disturbing the anastomosis (usually 1 inch [2 to 3
cm]).
• Administer chest physiotherapy as prescribed.
– Change the infant's position by turning; stimulate crying to
promote full expansion of lungs.
– Elevate head and shoulders 20 to 30 degrees.
– Use mechanical vibrator 2 to 3 days postoperatively (to
minimize trauma to anastomosis), followed by more
vigorous physical therapy after the 3rd day.
• Continue use of Isolette or radiant warmer with humidity](https://image.slidesharecdn.com/tracheoesophagealfistula-250225071441-4fc48829/85/Tracheoesophageal-fistula-for-bsc-nursing-42-320.jpg)
