Objective: Esophageal atresia with tracheoesophageal fistula (TEF) is a congenital defect of the digestive system in which esophagus is not connected to the stomach and formed an end pouch. There is also an abnormal connection between digestive (esophagus) and respiratory system (trachea). This condition requires surgery for long term survival. We present challenging case of esophageal atresia with TEF in preterm low birth weight neonates with MDR Sepsis.
Case: A female preterm baby was referred to the hospital at 16 days old. The patient born at 32 weeks gestational age delivered by emergency caesarian section due to placental abruption and high risk pregnancy from 33 years old mother G7P3A3.  During treatment in the first hospital, patient was assessed and treated with sepsis and acute respiratory distress but had no significant response. In additional, there was regurgitation and difficulty of breathing while given breast milk using orogastric tube. They suspected the patient to have atresia esophagus and consulted to the pediatric surgeon then referred to our NICU at 16 days old for further examination and treatment. Patient was prepared to be operated through MDR Sepsis and acute respiratory distress and at 22 days old pediatric surgeon and team performed the operation. The baby had been through surgery during MDR sepsis therapy, NEC and several apnea and bradycardia episodes. The baby finally survived the operation, resolved from MDR  sepsis, catching up for the birth weight and also the ability to feeding.
Conclusion: Surgery is the definite treatment for esophageal atresia with TEF. It is important to do an early detection of esophageal atresia with TEF, preparing optimal condition before surgery and not to delayed it even in complicated cases such as; preterm, MDR sepsis, and respiratory distress in order to achieve an optimal result.