Introduction: Tracheoesophageal fistula (TEF) is a common congenital anomaly requiring early surgical correction. Though survival has improved considerably , postoperative respiratory complications remain a major cause of morbidity . Phrenic nerve injury leading to hemi diaphragmatic paralysis (HDP) is a rare, recognized complication after thoracic surgery inneonates. Management ranges from respiratory support to surgical diaphragmatic plication. Case presentation: A baby boy delivered at term with 3kg, presented with vomiting, bubbling, cyanosis and was diagnosed to have TEF. Baby had undergone TEF repair on day 2. The study of the upper gastrointestinal contrast on day 13 revealed a successful repair with no anastomotic leak. Till day 45, extubation failure to Non-invasive positive pressure ventilation (NIPPV) and HFNO encountered thrice despite preextubation short course dexamethasone. Further imaging by CECT and USS chest concurrently revealed right side diaphragmatic paralysis. Though non-operative trial with continuous pressure support via HFNO was considered, due to progressive worsening diaphragmatic elevation and increasing oxygen requirement, right sided diaphragmatic plication surgery was performed on day 80 of life. Significant improvement in degree of respiratory distress noted postoperatively . HFNO therapy was weaned off by day 86 and baby was on room air with minimal chest indrawing. On 2-week post discharge review baby had no respiratory complications. Conclusion: HDP should be suspected in neonates with failed extubation after TEF repair. Initial conservative management is reasonable; however, persistent respiratory compromise or ventilator dependance should prompt early diagnosis and diaphragmatic plication to improve respiratory mechanics. Keywords: Tracheoesophageal fistula, Phrenic nerve injury , Hemi diaphragmatic paralysis.