Esophageal Atresia Louis Lopez Fresno City College RN 56 Diana Bellar Esophageal atresia Esophageal atresia (EA) is a birth defect that causes the lower end of the esophagus and stomach to not connect to the upper esophagus and the trachea. Baldwin and Yadav in Esophageal Atresia state the esophagus is created from the endogerm layer of the embryo which forms the pharynx, esophagus, stomach, and the epithelial lines of the aerodigestive tract. Conditions like tracheoesophageal fistula and esophageal atresia occur when the esophagus fails to separate from the lung bud in early fetal development due to defective epithelial-mesenchymal interactions. Due to this failure of separation, the esophagus and the trachea often form a fistula between the ends of each structure that forms into a pouch that inhibits the flow of and feedings and fluid that enters the digestive tract. Clinical manifestations of esophageal atresia begin while the child is in the womb. Diagnostic procedures like an ultrasound and amniocentesis can be done to determine the likelihood of a child being born with EA. Baldwin and Yadav state, “Prenatally, patients with EA may present with polyhydramnios, mostly in the third trimester, which may be a diagnostic clue to EA”. After birth, symptoms like excessive drooling and choking occur due to the inability of fluid to enter the digestive system. Along with these symptoms, around 50% of patients with EA have associated congenital anomalies including vertebral defects, anal atresia, cardiac defects, TEF, renal anomalies, and limb abnormalities (also known as VACTERL) or coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities (also known as CHARGE). These associated abnormalities occur due to all these structures sharing the same germ layer that has genetic deficiency. Nursing management of esophageal atresia in dependent on which step of repairing the defect the patient is in. Nasogastric tubes are placed on continuous suction until the child is able to undergo surgery. This suction removes fluid from the distal end of the upper esophagus to prevent aspiration into the airway. Once surgery can be performed, both ends of the esophagus are joined to restore normal function. A chest tube is also inserted during the procedure to drain excess fluid from the site. The nursing management of this tube requires monitoring the output and ensuring that the water seal is not bubbling. Post surgical care involves monitoring for signs of infection and administration of parenteral nutrition until the surgical site is healed. The primary care provider will order a nasogastric tube after the site is healed to begin feeding through the digestive tract. The nurse will need to monitor residual volumes between each feeding to prevent aspiration into the respiratory tract. The same will be done after it is deemed safe for the child to begin oral feedings. The nurse and mother will monitor how much the baby is eating, how they are tolerating feeding, and any signs of overfeeding like regurgitation or reflux. It is important for the nurse to educate the parents of a child who has had esophageal atresia. Many parents have anxieties with feeding their child out of fear of them choking. Educating them on the signs of overfeeding or intolerance to formulas can ease anxiety and provide them with the knowledge to care for their baby correctly. If the baby has associated conditions like VACTERL and CHARGE, they will also be corrected and the parents will need education on how to care for those conditions as well. The goal is for the parents to take them home on oral feedings so they can begin normal functioning of their lives. Most children who have had this abnormality repaired show no residual signs of the disorder and live as if it never occurred. References Baldwin, D., & Yadav, D. (2023, July 23). Esophageal atresia - statpearls - NCBI bookshelf. National Library of Medicine National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK560848/ Belleza, M. (2023, July 22). Tracheoesophageal Atresia Nursing Care Management and Study Guide. Nurseslabs. https://nurseslabs.com/tracheoesophageal-atresia/
