A male infant with a birthweight of 2,500 g (between the 3rd and 10th percentile) is born at 37 weeks’ gestation to a 27-year-old primigravida woman with severe polyhydramnios (amniotic fluid index of 37 cm). After delivery, the neonate is vigorous, with Apgar scores of 8 and 9 at 1 and 5 minutes of age, respectively. He develops excessive frothy oral secretions, and the neonatology team is unable to pass a nasogastric tube. Chest radiography shows the coiling of a nasogastric tube with air in the stomach suggestive of esophageal atresia (EA) with tracheoesophageal fistula (TEF).

On day 4 of age, a primary surgical repair of the TEF with eso-esophageal anastomosis is performed under mild tension. Initially, the neonate receives minimal ventilator settings (mean airway pressure 8 cm H2O, positive end-expiratory pressure of 5 cm H2O, and fraction of inspired oxygen [FiO2] 0.21) for...

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