ABSTRACT
A fatality from an acquired tracheoesophageal fistula (TEF) in a very low birthweight
premature infant is presented. Neonatal tracheal and esophageal injuries related to
endotracheal (ET) intubation are discussed. The infant had important risk factors
for the development of subglottic stenosis: birthweight less than 1000 gm, prolonged
positive pressure ventilation, and repeated ET intubation. The pathologie examination
was consistent with acquired fistula formation resulting from a combination of preexisting
subglottic stenosis and prolonged and repeated ET intubation. The recognition of clinical
signs of an acquired TEF, as observed in our patient, followed by expeditious diagnostic
testing may be lifesaving.
