Emergency Out-of-Hospital Presentation of Neonatal Esophageal Atresia with Tracheoesophageal Fistula

In Germany, esophageal atresia (EA) occurs with a prevalence of 2.27 (Saxony-Anhalt) to 4.5 (Mainz) per 10 000 births (Pedersen RN et al., Arch Dis Child 2012; 97: 227–232). This prevalence has been stable over the last 20 years (EUROCAT). In at least 4 out of 5 of cases, EA is associated with a tracheoesophageal fistula (TEF), and type Vogt III b with TEF of the lower esophageal segment is the most common variant. Excessive salivation due to the inability to swallow (“bubble blowing neonate”), cyanotic attacks, and respiratory distress should lead to immediate suspicion of EA (Zwaan E et al. Ned Tijdschr Geneeskd 2013; 157: A5633).

A proper diagnosis allows for a timely closure of the TEF and end-to-end anastomosis of the esophagus with excellent results (Lacher M et al. Klin Padiatr 2010; 222: 296–301). We report an anecdotal case of an outdoor emergency due to a delayed diagnosis of EA with TEF. The purpose of this paper is to demonstrate the importance of proper examination at birth and to reiterate the complex pathophysiology of this malformation.