[The bubble-blowing neonate: a red flag for oesophageal atresia]

When a newborn develops feeding difficulties, is blowing bubbles or has excessive saliva, it is important to consider the diagnosis of oesophageal atresia. Prenatal detection of oesophageal atresia is difficult. Postnatal bubble blowing, resulting from the inability to swallow excessive oropharyngeal secretions, is pathognomonic. These symptoms should trigger the midwife or physician to consider this diagnosis. We present three cases to illustrate the difficulties of early recognition and the consequences of a late detection of this condition. The first and third cases show that a delayed diagnosis of oesophageal atresia can lead to dangerous situations. Our second case illustrates that not every poorly drinking neonate has oesophageal atresia, and that this diagnosis may be rejected if the physician is able to pass a nasogastric tube. In every neonate who is unable to drink, we advise attempting to pass a nasogastric tube and taking a chest x-ray to distinguish between oesophageal atresia and other causes of feeding problems.