Unusual Presentation of Tracheoesophageal Fistula With Meconium Aspiration Syndrome in A Preterm Infant - Unusual Presentation of Tracheoesophageal Fistula With Meconium Aspiration Syndrome in A Preterm Infant - Open Access Pub

Congenital malformations usually occur during organogenesis and result in complete or partial absence of an anatomical part or alteration in its normal configuration. Major structural anomalies occur in 2-3% of live births.The reported global incidence of tracheoesophageal fistula is roughly 1 in 2,500 live births and in Pakistan, incidence is only reported by those tertiary care centers which have paediatric surgery facilities available.We report a case of esophageal atresia (OA) with tracheoesophageal fistula (TEF) associated with meconium aspiration syndrome (MAS) in an infant. Reporting this anomaly highlights the importance of early diagnosis and thorough clinical examination of a newborn, signifying that a meticulous prenatal workup should be conducted. TEF/OA should be suspected in any newborn presenting with respiratory distress, especially cough, emesis and/or cyanosis during feeds, history of polyhydrominos and inability to pass nasogastric tube. The parents should also be counseled regarding future pregnancies as it carries a 1% risk of recurrence. DOI10.14302/issn.2574-4526.jddd-17-1454 Thomas Gibson, is credited for describing the first case of oesophageal atresia (OA) and tracheoesophageal fistula (TEF) and Thomas Hill, noted the second case of OA with an associated anomaly of an imperforate anus. While some newborns may have TEF, about 4% of newborns with TEF do not have OA.1 the incidence of OA is 1 in 2500 live births and 86% of cases are associated with TEF.2 There is 0.5 to 2% risk of recurrence among siblings of affected child.3 However, in Pakistan, only tertiary care centers which have paediatric surgery facility report anomaly cases4. Here we present a case TEF with OA, associated with meconium aspiration syndrome (MAS) in an infant. We aim to highlight the importance of conducting a comprehensive antenatal and prenatal workup in newborns to avoid management difficulties after birth and prevent an avoidable fatality. Also, to highlight an early diagnosis if a baby has respiratory distress and ther is failure to pass nasogastric tube and an X-ray which indicates a coiled tube in esophagus and intestinal air suggesting TEF. A 2 day old female, weighing 2.3 kg, born at 34 weeks, presented in the emergency department with complaints of fever, drooling with breathing and feeding difficulties. She had been delivered in a private clinic. Her mother was a primigravida with no significant prenatal history except hypertension in second trimester with use of antihypertensive drugs. There was no use of contraceptives pills or exposure to