My baby can't swallow: PGI gets 250 cases a year

New-borns who discharge a lot of saliva, breathe with difficulty, and can't take in 

feed need to be checked for a common birth defect--incomplete food pipe--of 

which the PGI receives 250 surgical emergencies a year from around the north region.

The medical term for it is trachea-oesophageal fistula (TEF)--a condition 

characterised by abnormal communication between the oesophagus (food pipe) 

and the trachea (windpipe). It may be congenital (present since birth) or acquired 

(developed due to some disease). The elite medical institute in Chandigarh has 19

 new-borns in its surgical intensive care unit (ICU) who have TEF and associated 

anomalies.And this is the highest number at any given time in India.

Congenital TEF is a common abnormality of the upper respiratory and digestive 

tract, affecting 1 in 3,000 births with increased risk in case there's also family 

history of this defect.The causes range from chromosomal abnormalities and 

environmental factors. The TEF may lead to other organ abnormalities--of the 

heart (13-34%), backbone (6-21%), limbs (5-9%), anus and rectum (10-16%), 

and kidneys (5-14%).

The affected babies need a vigilant paediatrician (child doctor) or a GP (general 

practitioner) who can refer them to a paediatric (child) surgeon.“The PGI gets 

so many cases of TEF because the defect has a large catchment area in north 

India--covering Jammu and Kashmir, Punjab, Himachal Pradesh, Haryana, 

Uttarakhand, and parts of western Uttar Pradesh,“ PGI's paediatric surgery 

department head Dr Ram Samujh said. “Many of these states are devoid of 

expert child surgeons to deal with these cases.“

Child surgeon Dr JK Mahajan recommends long-term follow-up with periodic 

X-ray tests to TEF babies, because they run a risk of developing gastrooesophageal 

reflux (in which stomach contents retreat to the food pipe), recurrent cough 

and chest infections, and tightening of the food pipe. It requires surgery and upper 

GI endoscopy (a look inside the food pipe).The survival of the operatedupon 

babies depends upon prematurity , birth weight, and associated organ abnormalities.

Instead of a complete food pipe, the TEF babies have two pouches (upper and lower) 

separated by a gap. Common types include a blind-ended upper pouch (not connected 

normally to the stomach) and a lower pouch connected to the windpipe.

Source: The Times of India