Atypical presentation of esophageal atresia with tracheoesophageal fistula

Esophageal atresia (EA) with tracheoesophageal fistula (TEF) or "type C" TEF is the most common form of EA which occurs in approximately 1 in 4,000 live births and is associated with other congenital anomalies in 50% of the cases. Early diagnosis is essential if aspiration pneumonitis is to be avoided and corrective surgery performed before pulmonary complications occur. We report three infants who presented with unusual symptoms and where the diagnosis was delayed. Health care workers need to have a high index of suspicion for TEF when it presents in a non-classical manner.