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Two neonates developed sialorrhoea and feeds intolerance. A nasogastric tube (NGT) was passed with difficulty and its gastric position confirmed radiologically in both (figure 1A,B). Oesophageal atresia with tracheo-oesophageal fistula (OA/TOF) was therefore ‘excluded’. However, the babies continued to chock with feeds.
A second attempt at inserting a NGT was unsuccessful and further radiographs showed coiled tubes in the upper oesophagus. The oesophageal continuity was tested with a 10 Fr Replogle tube which stopped at about 10 cm from the nostril. Contrast radiographs with the Replogle in place made the diagnosis of OA/TOF in both neonates (figure 2) and confirmed at surgery.
‘Successful’ passage of the NGT is often defined by the length of tube inserted and a pH test, but neither test can exclude passage to the stomach by an abnormal route. An antero-posterior film might highlight a minor deviation from the midline4; a lateral chest x-ray is not routinely indicated. If a baby remains symptomatic in spite of ‘successful’ passage of a NGT, the possibility of OA/TOF should still be considered, a further attempt at passage of a stiff 10 Fr catheter should be undertaken and, where doubt persists, a contrast radiograph should be performed by an experienced radiologist.5
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.