Tracing the Pathway to Care: Pre-Hospital Delays and In-Hospital Morbidity in Children With Esophageal Atresia and Type-C Tracheoesophageal Fistula.

Delays along the referral and care pathway for neonatal tracheoesophageal fistula in low-resource settings remain understudied despite their impact on preventable mortality. This case series was done at Pakistan Institute of Medical Sciences. All neonates with confirmed tracheoesophageal fistula were included in the study, enrolling 15 patients, two of which were excluded. Data collection included admission variables, prehospital and in-hospital care timelines. Misdiagnosis occurred in 46.15% of the cases. Time to correct diagnosis from first health-care contact was shorter in survivors (24) than post-operative non-survivors (48). Survival was 71.4% with private transport, whereas all brought via public transport or ambulance died. Overall, in-hospital mortality was 61.5% including three preoperative deaths and five postoperative deaths, and being frequently associated with sepsis, initial misdiagnosis and NICU unavailability. NICU beds remained unavailable for 7/8 non-survivors throughout. Addressing identified gaps may reduce EA/TEF mortality and establishing registries and structured surveillance are essential in Pakistan.