Jaslok Hospital Treats 30-Week Premature Infant with Rare Tracheo-Oesophageal Fistula in Single-Stage Surgery

Mumbai: A rare birth anomaly in a premature infant was corrected through a single-stage surgery and oesophageal dilatation, in what the team at Jaslok Hospital and Research Centre, Mumbai, describes as a first-of-its-kind clinical feat.

The hospital successfully treated a 30-week-old premature baby born in Vapi, Gujarat, with a birth weight of just 1.3 kg and diagnosed with Type C Tracheo-oesophageal Fistula (TEF), a congenital condition in which the windpipe and food pipe are abnormally connected.

This can lead to excessive salivation, choking, and a high risk of lung infection. The surgical team at Jaslok performed a single-stage corrective surgery followed by oesophageal dilatation. The baby, now weighing 1.8 kg, is exclusively breastfed and ready for discharge.

The baby’s parents contacted Dr Fazal Nabi, Director – Paediatrics at Jaslok Hospital, for higher treatment options.

Considering the complexity of the case, Dr Nabi personally travelled to Vapi to ensure safe transport of the infant, who was brought to Jaslok Hospital under his expert monitoring and artificial ventilation.

On arrival, the baby was admitted to the Paediatric Intensive Care Unit (PICU), where he was placed on ventilator support, given haemodynamic stabilisation with inotropes, and started on intensive sepsis management.

Dr Nargish Barsivala, Paediatric Surgeon at Jaslok Hospital, was consulted and advised that a one-stage surgery would be the most appropriate approach once the baby was stabilised.

On the third day of admission, Dr Barsivala performed the single-stage corrective surgery, involving ligation of the fistula and end-to-end oesophageal anastomosis. Post-surgery, the baby returned to intensive care.

In the following days, the team encountered further complications. Due to the baby’s prematurity and low birth weight, intestinal movement was sluggish.

The baby was put on nasogastric (NG) tube feeding along with partial total parenteral nutrition (TPN). Swallowing remained a challenge. After nearly a month, a decision was taken to perform a feeding gastrostomy and the NG tube was removed.

However, the baby continued to experience difficulty swallowing. To address this, the team opted for a high-risk oesophageal dilatation using the smallest available dilator.

The procedure was carried out by Dr Pankaj Dhawan, Consultant – Gastroenterology, with support from the PICU team led by Dr Fazal Nabi, Dr Barsivala, and the anaesthesia team.

Gradually, the baby began swallowing independently, leading to complete removal of the NG tube.

“When the baby was brought in, he was struggling — tiny, fragile, and in urgent need of care,” said Dr Fazal Nabi, Director – Paediatrics, Jaslok Hospital & Research Centre. “From stabilising him on arrival to managing post-surgical complications, every step had to be timed and tailored. The oesophageal dilatation was particularly challenging, but the team worked in perfect sync. Watching him now, feeding on his own and ready to go home, is a reminder of why we do what we do. It was a team effort from start to finish, and I am grateful for the critical support.”

“Operating on a premature baby weighing just over a kilo is never easy,” said Dr Nargish Barsivala, Consultant – Paediatric Surgery, Jaslok Hospital & Research Centre. “The tissues are extremely delicate, and the margin for error is almost zero. But given the nature of the condition, waiting wasn’t an option. We decided to go ahead with a single-stage repair, knowing the risks but also the long-term benefits. The successful outcome was made possible by the precise surgical expertise, expert anaesthesia support by Dr Rajani Prajish and assisting help from Dr Kotawala and the surgical residents.”

Expressing her gratitude, the baby’s mother, Mrs Trupti, said, “My baby is a precious baby born after 8 years of marriage with IVF support. When my baby was born so early and so fragile, I feared the worst. However, the care and dedication shown by the doctors and staff at Jaslok Hospital gave me hope. I truly believe that without their expertise and compassion, my child would not be here today.”

Dr Milind Khadke, Chief Medical Officer, Jaslok Hospital, said, “It is the clinical excellence and cutting-edge technology behind saving a 30-week premature baby with Tracheo-oesophageal fistula—a rare, life-threatening condition. Despite low birth-weight and under 50% survival odds, the landmark surgery showcases the hospital’s advanced neonatal care and surgical expertise.”

The family has now been counselled on safe feeding practices, medication schedules, and key warning signs to monitor as they prepare to take the baby home.