Delhi doctors repair rare oesophageal defect in 1.4-kg premature newborn 

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Doctors at a Delhi hospital have successfully performed a complex surgery to repair a life-threatening congenital oesophageal defect in a premature newborn weighing just 1.4 kg, one of a pair of twins.

The baby, born at 34 weeks of gestation, was diagnosed with Type C tracheo-oesophageal fistula (TEF) with oesophageal atresia, a rare congenital condition in which the upper part of the oesophagus ends in a blind pouch while the lower segment is abnormally connected to the trachea, doctors at Yashoda Super Speciality Hospital, Kaushambi, said.

Soon after birth, the newborn developed frothing at the mouth, excessive secretions and respiratory distress. The diagnosis was confirmed through an X-ray, which showed the feeding tube coiling in the upper oesophagus.

The two-hour surgery was performed by Dr Minu Bajpai, paediatric surgeon at the hospital and former head of the Department of Paediatric Surgery at AIIMS-Delhi. The procedure involved joining the two ends of the oesophagus despite a wide gap equivalent to three vertebral bodies.

“The inability to safely undertake a primary oesophageal anastomosis is significantly higher in very low birth weight infants, with around 54 per cent requiring alternative approaches. Prematurity further reduces survival,” Bajpai said.

Bajpai said successful primary repair in premature babies weighing around 1.4 kg remains uncommon, with reported success rates ranging between 14 and 43 per cent. He said a post-operative contrast study showed good swallowing with smooth passage of food into the stomach, indicating a successful repair.

The baby also had patent ductus arteriosus (PDA), a congenital heart condition commonly seen in premature infants, adding to the complexity of treatment, he said.

TEF with oesophageal atresia is an uncommon congenital anomaly occurring in approximately one in every 2,500 to 4,500 live births worldwide and is among the most common congenital abnormalities affecting the oesophagus.

The surgery was supported by neonatologist Dr Deepika, anaesthetist Dr Shekhar Garg and specialised neonatal intensive care and nursing teams.

Bajpai said advances in neonatal intensive care, anaesthesia and paediatric surgery have improved outcomes in such high-risk newborns, although survival continues to depend on factors such as birth weight, prematurity and associated congenital anomalies. 

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