Bronchoscopic Localization of Tracheoesophageal Fistula in Newborns With Esophageal Atresia: Intubate Above or Below the Fistula?

Abstract

PurposeIn neonates with suspected type C esophageal atresia and tracheoesophageal fistula (EA/TEF) who require preoperative intubation, some texts advocate for attempted “deep” or distal-to-fistula intubation. However, this can lead to gastric distension and ventilatory compromise if a distal fistula is accidentally intubated. This study examines the distribution of tracheoesophageal fistula locations in neonates with type C EA/TEF as determined by intraoperative bronchoscopy. MethodsThis was a single-center retrospective review of neonates with suspected type C EA/TEF who underwent primary repair with intraoperative bronchoscopy between 2010-2020. Data were collected on demographics and fistula location during bronchoscopic evaluation. Fistula location was categorized as amenable to blind deep intubation (>1.5 cm above carina) or not amenable to blind deep intubation intubation (<1.5 cm above carina or carinal). ResultsSixty-nine neonates underwent primary repair of Type C EA/TEF with intraoperative bronchoscopy during the study period. Three patients did not have documented fistula locations and were excluded (n=66). In total, 49 (74%) of patients were found to have fistulas located <1.5 cm from the carina that were not amenable to blind deep intubation. Only 17 patients (26%) had fistulas >1.5 cm above carina potentially amenable to blind deep intubation. ConclusionsMost neonates with suspected type C esophageal atresia and tracheoesophageal fistula have distal tracheal and carinal fistulas that are not amenable to blind deep intubation. Level of EvidenceLevel III.