What is the recommended positioning for an infant with tracheo-esophageal fistula with esophageal atresia?

In the case of an infant with tracheo-esophageal fistula (TEF) and esophageal atresia, the recommended positioning is to elevate the head of the bed by 30 degrees. This positioning helps to reduce the risk of aspiration and allows gravity to assist with drainage, minimizing the likelihood of secretions pooling in the airway.

When an infant has TEF and esophageal atresia, there is a concern for the respiratory system due to the potential for food and liquid to enter the trachea instead of the esophagus. Elevating the head helps prevent reflux of stomach contents and supports respiratory function by ensuring the airway remains clear.

Laying flat on their back may lead to increased risk of aspiration, while sidelying positions, though they could provide some benefit in certain contexts, are not as effective in promoting drainage and preventing aspiration as a head-up position. A sitting position is typically not recommended for infants as it can lead to discomfort and potential airway compromise. Thus, the optimal choice is to have the head of the bed elevated to encourage safer respiratory dynamics.