What are the three signs to look for at first feeding if an infant has tracheo-esophageal fistula with esophageal atresia?

In the context of tracheo-esophageal fistula (TEF) with esophageal atresia, the correct signs to monitor during the first feeding are coughing, choking, and cyanosis.

Coughing is a reflex action that may occur when feeding because the abnormal connection between the trachea and esophagus allows milk to enter the airway instead of the stomach. Choking can happen as a direct result of this aspiration, where the infant struggles to breathe due to milk obstructing the airway. Cyanosis, which is a bluish discoloration of the skin, indicates a lack of oxygen, which can occur if the infant is aspirating during feeding, leading to respiratory distress.

These signs are critical to identify because they highlight the immediate risks to the infant's airway and overall health during feeding attempts. The other options include symptoms that are not directly related to the immediate response of an infant with TEF and esophageal atresia during feedings, which makes them less relevant to this specific situation.