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Abstract
A preterm newborn required pulmonary surfactant administration and high frequency
oscillatory ventilation due to respiratory distress syndrome. VACTERL association
was suspected after diagnosis of several congenital anomalies (butterfly vertebra,
double left ureteral system, double outlet right ventricle and limbs anomalies). A
nasogastric tube was passed and tip position was confirmed in the stomach (Fig.1A).
He experienced problems due to high leaks rate by endotracheal tube and progressive
gastric distension, which led to esophageal atresia suspicion despite image of the
tube tip into the stomach. An esophagogastric contrast study was performed to rule
out tracheoesophageal fistula, showing a proximal esophageal pouch (Fig.1B). The newborn
died 48 hours after birth due to hypoxemic respiratory failure. Autopsy confirmed
an esophageal atresia type IV, with proximal and distal tracheoesophageal fistula.
The passage of a nasogastric tube does not always exclude the presence of an esophageal
atresia. Nasogastric tubes that passes through the larynx, the trachea and the distal
fistula and reaches the stomach have been described [1-3]. In our case, nasogastric
tube could reach the airway through the upper fistula and then through the inferior
fistula reach to the digestive tract.
Footnotes
Source of Support: None
Conflict of Interest: None
[]
Neonatal Intensive Care Unit, Hospital Universitario Santa Lucía, Cartagena, Spain
Author notes
[*
]Correspondence: Jose María Lloreda-García, Neonatal Intensive Care Unit, Hospital
Universitario Santa Lucía, Cartagena, Spain
jmlloreda@
123456gmail.com
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