Neonatology and Perinatology

Biography

Neaha Patel graduated from University of Birmingham in 2013, and is currently an ST4 Paediatric registrar working in the Neonatal Intensive Care Unit at the Homerton University Hospital. She has a keen interest in Neonatology, and is completing her postgraduate diploma in Paediatric Infectious Diseases at Oxford University, with a view to develop an interest in Neonatal Infection. She has one published work in a reputed journal.

Abstract

A term male infant was admitted to the local neonatal unit at 18hours with respiratory distress and copious white secretions. He was intubated and ventilated; on chest x-ray (CXR) the nasogastric tube (NGT) was seen in the stomach and he was extubated shortly afterwards.

Six hours after extubation, he developed respiratory distress and was reintubated. The NGT was re-inserted but appeared coiled on repeat CXR, suggesting oesophageal atresia (OA) with tracheo-oesophageal fistula (TOF). He was transferred to our neonatal unit and had an uncomplicated surgical repair. Revisiting his initial CXR, the NGT can be seen parallel to the endotracheal tube, passing through the TOF into the oesophagus where a kink is seen, and onwards into the stomach. Post extubation, the oesophageal pouch appears as a lucency extending from the neck into the upper mediastinum.

In OA with distal TOF, an NGT coiled in the oesophageal pouch on CXR is usually diagnostic. Rarely, however, the NGT may enter the stomach via the trachea and fistula, as seen in this case. The key message is that neither an NGT in the stomach nor a positive pH test exclude OA with distal TOF. In H-type fistulae, the NGT would also appear in the stomach. Careful review of the CXR is advised to avoid delaying diagnosis; an NGT travelling alongside the endotracheal tube, or a kink in its course, may act as indicator.