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Tracheoesophageal fistula (TEF) and esophageal atresia are congenital anomalies where the esophagus fails to develop properly, often occurring together in newborns. Esophageal atresia involves discontinuity of the esophagus, while TEF represents an abnormal connection between the trachea and esophagus. These conditions require immediate surgical intervention and occur in approximately 1 in 3,000-5,000 live births.
During embryonic development around 4-6 weeks gestation, the tracheoesophageal septum fails to properly separate the primitive foregut into distinct tracheal and esophageal tubes. This developmental failure results in various anatomical configurations, with Type C (esophageal atresia with distal TEF) being most common, accounting for 85% of cases. The abnormal anatomy prevents normal swallowing and can lead to aspiration of gastric contents into the respiratory tract.
Newborns present with inability to swallow, excessive drooling, choking with feeding attempts, and respiratory distress due to aspiration. The classic triad includes inability to pass a nasogastric tube, excessive oral secretions, and respiratory symptoms that worsen with feeding. Early recognition is crucial as delayed diagnosis increases morbidity and mortality risk from aspiration pneumonia and respiratory complications.