<prompt> Which one of the following life-threatening congenital anomalies in the newborn presents with polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube?GastroschisisDiaphragmatic herniaTracheo-esophageal fistulaChoanal atresia  <response>: c. Tracheo-esophageal fistulaRef: Nelsons 20e p 1783, Ghai 8e p 176Presence of polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube all point towards a diagnosis of tracheoesophageal fistula, which is usually accompanied by esophageal atresia.Esophageal atresia EA and TEF Tracheoesophageal fistula:Important features EA is the most frequent congenital anomaly of esophagus; 90 of EA babies have TEF Most common type is upper esophagus ends in a blind pouch and TEF connected to distal esophagusTypical presentation Maternal polyhydramnios is seen; New born presents with respiratory distress and excess oral frothing; Newborn regurgitates all of its feeds; Saliva pours almost continuously from the mouth of the infant Attacks of coughing and cyanosis occurs on feeding; Feeding tube cannot be passed more than 10cmDiagnosis Chest X-ray with a red rubber catheter passed per orally shows coiled rubber catheter in a lucent proximal esophageal pouch X-ray abdomen; Gas in the stomach is seen if there is communication between the lower part of the esophagus and trachea, which occurs in the commonest variety of tracheoesophageal fistula 