A newborn infant develops coughing, choking and cyanosis with his first feeding. He is noted to have excessive drooling. What are the important associated anomalies that must be screened for prior to surgical intervention?

c. Genitourinary obstruction

This child has a classical history for esophageal atresia and has a very high (90% or more) probability of a distal tracheoesophageal fistula. The simplest way to establish the diagnosis is to attempt to pass a catheter through the mouth or nose into the stomach. If the tube encounters obstruction, a plain radiograph should document the atresia.

Patients with esophageal atresia and tracheoesophageal fistula frequently have associated anomalies. This incidence is about 30% to 50% in most reports. Anomalies vary from minor skeletal deformities to uncorrectable cardiac defects. The most common associated anomalies are cardiac and gastrointestinal, especially imperforate anus (10%). Vertebral, genitourinary and limb anomalies are also seen. Importantly, approximately 5% of patients with esophageal atresia have a right-sided aortic arch. This is an important technical issue as the normal approach is via a right thoracotomy and this should be changed to a left thoracotomy in the presence of this finding. There is no association with hydrocephalus.