“…As a consequence, the loss of ventilation and the progressive gastric distension will worsen the respiratory distress syndrome, also facilitating gastroesophageal reflux and inhalation, increasing the risk of gastric perforation with high mortality rate. 8 For VLBW neonates with EA/TEF and respiratory distress, several maneuvers have been suggested to prevent or to stop the air leak through the fistula, including gastric division, 9 silastic banding of the distal esophagus, 10 distal positioning of the endotracheal tube with the bevel pointing anteriorly, 11 antegrade 12 or retrograde 13,14 occlusion of the fistula with a Fogarty balloon, water-seal gastrostomy, 15 and high-frequency ventilation. 16 Most recent series suggest early thoracotomy with ligation of the fistula.…”