A 1-day-old full-term female newborn is brought to the neonatal intensive care unit (NICU) shortly after birth due to feeding difficulties and excessive drooling. The parents report that every time they try to feed her, she coughs and seems to choke. There is also noticeable frothing at her mouth. The baby has not passed any meconium, and her breathing appears labored.

Physical examination reveals a healthy-appearing newborn, but with signs of respiratory distress and difficulty swallowing. The medical team suspects a congenital anomaly and orders an X-ray after attempting to pass a nasogastric tube, which coils in the upper esophagus. A diagnosis of tracheoesophageal fistula (TEF) with esophageal atresia is confirmed.

In this case, the esophagus is not fully connected to the stomach, and there is an abnormal connection (fistula) between the esophagus and the trachea. This explains the baby’s feeding difficulties and risk of aspiration. The pediatric surgical team is consulted, and surgery is planned to repair the defect.

The parents are informed about the condition and reassured that surgical correction, although urgent, is a common procedure with a good prognosis. The baby is placed on intravenous fluids and kept on a feeding tube until the surgical repair. A multidisciplinary team will continue to monitor the newborn closely post-operatively to ensure no complications arise, including risk of aspiration pneumonia or strictures at the repair site.

The parents are advised about long-term follow-up, as children with TEF can sometimes experience feeding or respiratory difficulties later in childhood. However, with timely intervention, the outlook is generally favorable.