A tracheoesophageal fistula (TEF) is a congenital anomaly that occurs when the separation of the esophagus and trachea is incomplete. An H-type TEF is found in less than 5% of all TEFs. (1) Symptoms are often subtle; therefore, diagnosis is often difficult and delayed, increasing the morbidity and mortality for infants.

A male neonate is born at 40 weeks’ gestational age to a 28-year-old gravida 1, para 0 woman with good prenatal care at a birthing center. The birth history is significant for rupture of membranes 23 hours before delivery, meconium-stained fluid, and water birth at the birthing center. He requires stimulation, suction, and positive pressure ventilation for 1 minute. The Apgar score at 1 minute is not recorded and is 10 at 5 minutes. He is discharged from the birthing center 5 hours after birth. On day 2 after birth, the neonate is brought to the lactation...

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