Rare Type A Esophageal Atresia: Successful Neonatal Management with Awake Intubation

Abstract Esophageal atresia (EA) is a rare congenital anomaly characterized by esophageal discontinuity. Type A EA, the rarest subtype, occurs in approximately 1% of cases and is not associated with a tracheoesophageal fistula, making its diagnosis and management particularly challenging. This report highlights the successful management of a neonate with Type A EA, complicated by neonatal pneumonia and congenital heart defects, using awake intubation. A 4-day-old neonate weighing 1715 grams presented with respiratory distress, hypersalivation, and failure to pass a nasogastric tube beyond 8 cm. Diagnostic imaging confirmed Type A EA, while echocardiography revealed ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Awake intubation was performed with ketamine induction and an uncuffed endotracheal tube to maintain spontaneous breathing and avoid airway collapse. Thoracotomy with primary esophageal anastomosis was successfully performed, despite two episodes of intraoperative desaturation, which were resolved by repositioning the head and re-evaluating the tube. Postoperative analgesia was managed with Fentanyl, and the patient showed stable recovery in the NICU. This case highlights the importance of early diagnosis, multidisciplinary care, and precise airway management for Type A EA. Awake intubation proved to be a safe and effective approach, ensuring optimal surgical outcomes.