The neonate born at 34-weeks estimated gestational age had Apgar scores of 3 and 7 at 1 and 5 minutes, respectively and is taken to the nursery for observation due to a need for continuous positive airway pressure (CPAP). Significant oral secretions are noted and an orogastric tube is unable to be placed because it meets resistance and comes back out the mouth. The nurse suspects which condition?

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Esophageal atresia. Significant oral secretions and an inability to pass an orogastric tube point to a diagnosis of esophageal atresia (EA). Although EA may present with tracheoesophageal fistula (TEF), these symptoms are more consistent with esophageal atresia. The need for CPAP after birth is consistent with 34-weeks gestation and does not necessarily indicate TEF. Pyloric stenosis is characterized by projectile vomiting after eating. Choanal atresia is the blockage of the nasal passages and is characterized by the inability to pass a nasogastric tube.

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