Facharzt FMH Kinderchirurgie Practice Questions - Facharzt FMH Für Kinderchirurgie Spécialiste FMH En Chirurgie Pédiatrique Exam

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A full-term male newborn presents immediately after birth with excessive frothing, drooling of saliva from the mouth, and choking episodes during his first attempt at feeding. A 10-French Replogle tube is passed through the nose but arrests firmly at 9 cm from the nares. A chest and abdominal radiograph confirms the curled catheter in the upper blind esophageal pouch and shows normal gas distribution throughout the stomach and intestines. What is the most crucial initial preoperative management step prior to definitive surgical repair of this Gross Type C esophageal atresia with distal tracheoesophageal fistula?

Continuous low-intermittent suction to the upper esophageal pouch via a double-lumen Replogle catheter, head-of-bed elevation to 30–45 degrees, and an urgent echocardiogram to evaluate aortic arch anatomy and associated anomalies Immediate emergent endotracheal intubation with positive pressure ventilation and placement of a surgical gastrostomy tube within 2 hours of birth Administration of high-volume water-soluble contrast through the nasogastric tube under fluoroscopy to define the exact distance to the carina Aggressive bag-valve-mask manual ventilation to maintain alveolar expansion while transferring the infant to the operating theater

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