Ghaziabad: A premature baby born with a significant gap in his food pipe has undergone a rare single-stage surgery at a Ghaziabad private hospital in which doctors joined the two ends, making ingesting easier for the infant.One of a pair of twins, the newborn was also diagnosed with a congenital heart condition that added to the risks of the operation. His twin was healthy.The baby, born at 34 weeks and weighing 1.4kg, was brought in for treatment after the parents saw excessive frothing near his mouth, increased oral secretions and difficulty in breathing. An X-ray confirmed oesophageal atresia with a distal tracheo-oesophageal fistula (Type C TEF).In simple terms, the baby was born with an oesophagus — the tube that carries food from the mouth to the stomach — that was disconnected. The lower segment, instead of ending normally, was connected to the windpipe, or trachea. This meant that the baby could not swallow milk or even saliva normally and secretions could enter the lungs, increasing the risk of choking, breathing difficulty, aspiration and pneumonia.In many such cases, doctors may consider multiple-stage procedures, particularly when the baby is premature or has a very low birth weight.However, in this case, surgeons performed a single-stage primary repair, bringing the baby’s own oesophageal ends together. “No artificial material or graft was used. The procedure took around two hours,” said Dr Minu Bajpai, principal director and head of paediatric surgery and paediatric urology at Yashoda Cradle & Children Hospital, Yashoda Medicity.“The baby’s prematurity and weight made the operation particularly challenging. His organs were extremely small and required delicate handling and very fine suturing. He also had patent ductus arteriosus (PDA), a congenital heart condition in which a blood vessel that normally closes after birth remains open. Maintaining stable blood pressure and circulation during surgery required close coordination between the anaesthesia and neonatal intensive care teams,” she said.Following surgery, contrast studies showed that the repaired food pipe was allowing passage of fluids into the stomach. The baby is now swallowing milk.Doctors said the immediate surgical outcome was encouraging, but such repairs require close follow-up. “The repaired segment can sometimes narrow as it heals, potentially causing difficulty in swallowing. The baby will therefore need regular monitoring and calibration of the repaired segment for the next few months,” Bajpai said.Type C TEF with oesophageal atresia is a congenital condition which occurs in about one in 2,500 to 4,500 live births worldwide. “Its management becomes more challenging when associated with prematurity, very low birth weight and other congenital abnormalities,” said the doctor.
