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OA with TOF — RACP Paediatrics MCQ

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ModerateNeonatalOA with TOFRACP Paediatrics

A newborn has excessive drooling and choking with the first feed. A nasogastric tube cannot be advanced beyond 10 cm. Chest X-ray shows the NG tube coiled in the upper oesophageal pouch and gas in the stomach. What is the most likely diagnosis?

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Correct answer: E — Oesophageal atresia with TOF

Inability to pass an NG tube beyond ~10 cm with the tube coiling in the upper pouch, combined with gas in the stomach (indicating a distal tracheo-oesophageal fistula), is the most common type of oesophageal atresia (EA with distal TOF, type C, ~85%). The infant should be kept nil by mouth with continuous upper pouch suction, positioned upright, and prepared for surgical repair.

Reference: RCH Melbourne – 2023 – OA/TOF CPG; RACP Paediatric Curriculum – Neonatology