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In OA, the oesophagus doesn't form properly, creating an upper pouch and a lower segment. This causes food and saliva to get trapped in the upper pouch, unable to reach the stomach.
 

In TOF, the oesophagus and trachea are connected, allowing air into the stomach and stomach fluids into the lungs. This leads to breathing problems and a bluish skin colour right after birth.

Types of Tracheo-Oesophageal Fistula (TOF):

Type A: The oesophagus is split into two parts, both with closed ends - about 8% of cases.

Type B: The top part of the oesophagus is connected to the windpipe, and the bottom part is sealed off, forming a blind pouch. This happens in about 2% of cases.

Type C: The top part of the oesophagus ends in a blind pouch, and the bottom part connects to the windpipe - about 85% of cases.

Type D: Both parts of the oesophagus are connected to the windpipe - less than 1% of cases.

Type E: The oesophagus connects to the stomach as normal, but a small hole also connects it to the windpipe - about 4% of cases.

Before surgery, doctors place a Replogle tube through the baby’s nose and into the oesophagus.

The Replogle tube has two channels:

• one for draining fluids
• one for air.

This helps stop choking by letting fluids drain out instead of building up.
 

Surgery is the only way to fix OA/TOF. It is usually done within the first few days after birth. 

The surgery used will depend on the type of OA/TOF. The goal is to repair the fistula and join the two parts of the oesophagus. The join made during surgery is called an anastomosis.

The surgery can be done in two ways:'

• keyhole or thoracoscopic surgery â€� this uses small cuts and a camera to do the surgery
• open surgery or thoracotomy â€� this involves a larger cut to access the oesophagus.
   

Long-gap OA is when the gap between the two ends of the oesophagus is too long for the surgeon to connect immediately.

The Foker Technique can be used to treat long-gap OA. It involves at least two surgeries.

1. First surgery - small stitches are attached to the ends of the oesophagus and are slowly tightened over days or weeks. This helps the oesophagus to grow.
2. Second surgery - the stitches are removed, and the oesophagus ends are joined together.

Some babies may need another procedure in between to place a gastrostomy (G) tube, which delivers milk or infant formula straight to the stomach.

Long-gap OA can be treated with an oesophagostomy, where the upper oesophagus is brought to an opening on the side of the neck. This stays for 1-2 years before surgery to join the oesophagus. The opening lets saliva drain onto a pad to prevent choking. 

A G-tube is placed to feed milk or formula directly to the stomach. Babies are also fed by breast or bottle during this time to practice sucking, with milk or infant formula flowing out of the neck opening to avoid choking. 

Long-gap OA can also be treated by waiting for the oesophagus to grow before it can be joined. Your baby will stay in hospital and will have:

• a Replogle tube to drain out fluids
• a g-tube to deliver milk or infant formula to the stomach.

Once you are confident in caring for your baby at home, you can be discharged until the next surgery.

All surgeries have a small risk of bleeding. Possible complications include:

• leaking
• narrowing of the oesophagus
• scarring.

These complications can be treated, and your child will have regular check-ups after surgery.

After surgery, your baby will be moved to the neonatal intensive care unit (NICU) for breathing support, monitoring, and pain relief.

Once stable, they will be moved to a ward and may be fed through a nasogastric tube or an intravenous (IV) cannula until they can start breastfeeding or bottle feeding. When your baby is feeding well and gaining weight, they will be ready to go home.
 

Babies born with OA/TOF who have no other associated health issues have an excellent outlook. This means they will usually grow well and lead active, healthy lives.

The outlook can vary if there are other health conditions, including

• being born very early
• having heart problems.

Your child may have some issues in the first few years after surgery, but these will usually improve over time.
 

Children with OA/TOF often have trouble feeding, but this usually gets better as they grow. You will be given a feeding plan specific to your baby’s needs.

Once allowed, babies with OA/TOF should start feeding from the breast or bottle. Smaller, more frequent feeds are usually recommended.

You can start giving solids around 6 months unless your doctor suggests otherwise.

Your child may find swallowing difficult and might take longer to move from smooth purees to foods with more texture. Some foods that might be harder to swallow include:

• unpureed meat
• bread
• hard, raw fruit and vegetables
• foods with skins, like grapes and tomatoes.

See a speech pathologist and dietitian for personalised advice on feeding and swallowing and to ensure your child is getting the right nutrition.

In some cases, the oesophagus can become narrow where it was joined together. This is called a stricture. 

Babies with a stricture may:

• have trouble swallowing
• vomit more
• choke or gag during feeding
• develop cyanosis - turn a bluish colour when they have difficulty breathing or swallowing.

A stricture is treated by a procedure called dilation, where the narrowed part of the oesophagus is gently stretched to make it wider. 

This procedure is done under general anaesthetic, which means your child will be asleep. 
 

Children with OA/TOF may develop gastro-oesophageal reflux disease (GERD), where stomach contents flow back into the oesophagus. This causes pain and sometimes vomiting. Treatment includes anti-reflux medication and regular check-ups with endoscopies.

If not treated, GERD can lead to Barrett’s oesophagus, where the oesophagus is damaged by acid. This can increase the risk of oesophageal cancer.

Children with OA/TOF are at risk of developing allergic inflammation of the oesophagus. This is called Eosinophilic Esophagitis (EoE).
EoE can cause worsening feeding problems or choking on food. Regular check-ups with endoscopies help diagnose and treat EoE early. Medications and diet changes can help reduce symptoms.
 

Children with OA/TOF may also have tracheomalacia. This is a floppy windpipe caused by underdeveloped cartilage. 

Tracheomalacia causes:

• noisy breathing
• a loud "barking" cough
• difficulty clearing phlegm
• breathing problems.

Barking coughs can make your child sound sick, but they do not necessarily mean they are.

Occasionally, food may get stuck in the food pipe, putting pressure on the windpipe. This makes breathing hard and can cause your child to turn red or blue. If this happens, contact your doctor immediately.

Children with OA/TOF may have frequent colds or pneumonia due to a weak windpipe that makes it hard to clear mucus. Chest physiotherapy can help, and the flu vaccine is recommended yearly to prevent pneumonia. Regular check-ups are important to manage ongoing issues and keep your child healthy.