Baby has esophageal atresia

What is esophageal atresia?

This anomaly does not make a lot of noise. However, in France, more than 200 babies are born each year with a “two-part” esophagus. It’s hard to imagine what it might look like …

Immediate and severe consequences for the newborn

In affected babies, the pipe connecting the mouth to the stomach is interrupted, in a cul-de-sac, a few centimeters below the throat. Suddenly, saliva and milk accumulate there and end up being spat out. No food can therefore naturally reach the stomach.

Why is this malformation serious for babies?

Better to be warned: esophageal atresia is not a benign abnormality.

In about one in two cases, it is associated with one or more other malformations (cardiovascular, vertebral, anal, renal …), often more complex to treat than atresia itself.

Esophageal atresia: where does this anomaly come from?

The origin of esophageal atresia still remains a great mystery … In the vast majority of cases, atresia of the esophagus occurs in isolation, without there being other cases in the family. However, the researchers do not rule out the genetic trail, especially when other malformations are present.

How to screen for esophageal atresia?

On the ultrasound of the second or third trimester of pregnancy, certain signs may suggest a malformation of the esophagus …

The baby with atresia is unable to swallow. In his mother’s womb, we note a buildup of amniotic fluid that the fetus cannot ingest (a hydramnios). Cécile, Emile’s mother, knows what it is. Pregnant, she had to undergo three pumpings: “it is true that my stomach was more tense than my first pregnancy, that I was also more tired, but I did not suspect anything abnormal ». Doctors removed the amniotic fluid that his son was not swallowing using a syringe.

A poorly or undeveloped stomach, a small baby can also alert the sonographer.

In case of suspicion, doctors perform a fetal MRI (Magnetic Resonance Imaging). This examination, if it confirms atresia, will also make it possible to determine the distance between the two segments of the esophagus.

Any associated malformations are also looked for and the mother-to-be will have to undergo an amniocentesis. There are, in fact, many cases of esophageal atresia in children with Down’s syndrome …

«As soon as she was born, they took her from me to clean her, do the usual exams, etc. They brought her back to me five minutes later, without telling me anything. There, I noticed that she was not swallowing. Bubbles were coming out of her nose, her mouth, I understood that something abnormal was happening“, Recalls Valérie, Charline’s mother. In his case, atresia was diagnosed within minutes of birth, when the esophagus is examined, to which all newborns are entitled.

Management of esophageal atresia

If esophageal atresia is diagnosed before birth and requires immediate intervention, the mother-to-be is guided to a type III maternity, equipped with a neonatal resuscitation service, to deliver her baby. Better to avoid a risky transfer, by ambulance or helicopter, on D-Day!

Sometimes the operation is performed a few months later. “For some types of atresia, it is more beneficial to wait several weeks. By the time the child grows a little and the tissues in the esophagus develop. Thus, the gap between the two segments is reduced, facilitating the intervention“, Explains Prof. Sarnacki.

How is the child fed until the operation?

The question we inevitably ask ourselves: how are these babies fed? The milk (breast or formula) is injected using a syringe into a tube connected to the stomach. A probe is also placed permanently in the mouth of the newborn to suck the saliva that he cannot swallow.

The course of the surgery

The operation consists of pulling a little on the two segments of the esophagus to hang them up. Five or six years ago it was common to connect them, when they were too far apart, with a piece of colon.

Today, we can also consider thoracoscopy, a method still little used, but promising. Few specialists have yet mastered this technique, which nevertheless has many advantages. Among other things: no ugly scar (three small holes are enough!) And a reduced risk of scoliosis in children with a spinal malformation.

The consequences of esophageal atresia

Often fed by a catheter during the first weeks of life, infants operated on for atresia generally do not know how to breastfeed. Parents and the nursing team are required, at all costs, to maintain the sucking reflex (with a pacifier, a finger, etc.) during the period of hospitalization. Because once you get home, you’ll have to learn to eat by mouth!

These children take more or less time to accept the bottle, the spoon… then, later, the pieces. Cécile, Emile’s mother, was right to persist: “We tried to put a spoon in her mouth every day for five months to no avail. And then one day, a miracle! He ended up accepting it. We also had recourse to a psychologist specializing in oral disorders to help her switch from milk to baby jars.«.

RGOs galore

Gastroesophageal reflux disease is a part of everyday life for babies born with atresia. It must be said that their digestive system is a little upset!

The only way to remedy this is to administer antacids to the child. A treatment that is important to follow to the letter, in order to avoid the risk of stenosis at the level of the suture of the esophagus (tightening of the tissues, preventing food from passing through).

On a daily basis, you have to adapt: ​​change Baby sitting in his deckchair rather than lying on his changing table, make him sleep on a semi-inclined mattress… to prevent him from choking on his lifts.

A weakened respiratory system

The surgical intervention, but also the gastroesophageal reflux, make sensitive the bronchi and the trachea of ​​the small “atresics”. Chronic cough or bronchitis recur frequently in these little ones. Almost half of them are hospitalized for respiratory problems, most of them before the age of 5.

Even if everything seems to be going for the best, regular medical monitoring should be imposed until the end of growth!

Esophageal atresia: useful contacts