{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:25:07Z","timestamp":1787300707094,"version":"build-2736575974"},"reference-count":17,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_crpm-2025-0016_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To detail the clinical presentation, diagnostic challenges and autopsy findings of a neonate with unanticipated Congenital High Airway Obstruction Syndrome (CHAOS) and esophageal atresia (EA) with tracheo-esophageal fistula (TEF), while noting the small stomach as\u00a0an observational prenatal finding in the absence of polyhydramnios that may prompt evaluation of the upper airway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_crpm-2025-0016_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>Thirty one weeks male neonate was born by vaginal delivery with severe respiratory distress following preterm prolonged rupture of membranes (PPROM) and placental abruption presenting with profound hypotonia and low Apgar scores. Antenatal imaging at 20 and 22\u00a0weeks had confirmed a small stomach and bilateral cerebral ventriculomegaly but consistently with normal amniotic fluid. Attempts at endotracheal intubation failed as the ETT could not be advanced past the vocal cords. During positive pressure ventilation (PPV), air was seen puffing in the neck, raising suspicion for upper airway obstruction. Emergency tracheostomy failed to achieve ventilation. Resuscitation was stopped about 90\u202fmin of life. Autopsy report showed congenital laryngeal\/tracheal atresia at the level of the cricoid cartilage, proximal esophageal atresia with Type C TEF, hypoplastic lungs and a small stomach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_crpm-2025-0016_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests that small stomach may be an observational prenatal finding for associated esophageal obstruction, prompting evaluation of the upper airway, especially in the setting of normal amniotic fluid. A high degree of suspicion for CHAOS should guide management in neonates presenting with severe respiratory distress and failed intubation. If difficult intubation is anticipated, ENT team availability will help for immediate tracheostomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/crpm-2025-0016","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:57:08Z","timestamp":1787299028000},"source":"Crossref","is-referenced-by-count":0,"title":["An unanticipated case of congenital high airway obstruction syndrome with type C tracheoesophageal fistula and cerebral ventriculomegaly in a preterm infant\u00a0\u2013\u00a0is a small stomach a remote clue?"],"prefix":"10.1515","volume":"15","author":[{"given":"Anitha","family":"Irakam","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics , Children\u2019s Hospital of New Jersey , Newark , NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Nayak","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics , Children\u2019s Hospital of New Jersey , Newark , NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Sunkad","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics , Children\u2019s Hospital of New Jersey , Newark , NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bellipady","family":"Rai","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics , Children\u2019s Hospital of New Jersey , Newark , NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"2026082107570339817_j_crpm-2025-0016_ref_001","doi-asserted-by":"crossref","unstructured":"Ergun, S, Tewfik, T, Daniel, S. Tracheal agenesis: a rare but fatal congenital anomaly. Mcgill J Med 2011;13:10\u201312. https:\/\/doi.org\/10.26443\/mjm.v13i1.241.","DOI":"10.26443\/mjm.v13i1.241"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_002","doi-asserted-by":"crossref","unstructured":"Spitz, L. Oesophageal atresia. Orphanet J Rare Dis 2007;11:2\u201313. https:\/\/doi.org\/10.1186\/1750-1172-2-24.","DOI":"10.1186\/1750-1172-2-24"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_003","doi-asserted-by":"crossref","unstructured":"Mudaliyar, US, Sreedhar, S. Chaos syndrome. BJR Case Rep 2017;3. https:\/\/doi.org\/10.1259\/bjrcr.20160046.","DOI":"10.1259\/bjrcr.20160046"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_004","doi-asserted-by":"crossref","unstructured":"Cohen, MS, Rothschild, MA, Moscoso, J, Shlasko, E. Perinatal management of unanticipated congenital laryngeal atresia. Arch Otolaryngol Head Neck Surg 1998;124:1368\u201371. https:\/\/doi.org\/10.1001\/archotol.124.12.1368.","DOI":"10.1001\/archotol.124.12.1368"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_005","doi-asserted-by":"crossref","unstructured":"Heriseanu, C, Bizubac, M, Draghia, L, Marcu, V, Gheorghe, D, Cirstoveanu, C. Congenital high airway obstructive syndrome (CHAOS) survival of a newborn with laryngeal atresia. Diagnostics 2023;13:3658. https:\/\/doi.org\/10.3390\/diagnostics13243658.","DOI":"10.3390\/diagnostics13243658"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_006","doi-asserted-by":"crossref","unstructured":"Soni, L, Prasad, G, Kaur, M. A case of antenatally undiagnosed laryngeal atresia with tracheo-esophageal fistula with airway obstruction at birth and its management. Pediatric Anesth 2024;34:175\u20137. https:\/\/doi.org\/10.1111\/pan.14794.","DOI":"10.1111\/pan.14794"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_007","doi-asserted-by":"crossref","unstructured":"\\Wu, Y, Hsiao, C, Chen, Y, Tsai, L, Mu, S. Rare type of tracheal agenesis: unexpected presentation and immediate consideration of emergent esophageal intubation in neonatal resuscitation program. Case reports and review of the literature. Pediatr Pulmonol 2024;59:1757\u201364. https:\/\/doi.org\/10.1002\/ppul.26990.","DOI":"10.1002\/ppul.26990"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_008","doi-asserted-by":"crossref","unstructured":"Kanamori, Y, Kitano, Y, Hashizume, K, Sugiyama, M, Tomonaga, T, Takayasu, H, et al.. A case of laryngeal atresia (congenital high airway obstruction syndrome) with chromosome 5p deletion syndrome rescued by ex utero intrapartum treatment. J\u00a0Pediatr Surg 2004;39:E25\u20138. https:\/\/doi.org\/10.1016\/j.jpedsurg.2003.09.041.","DOI":"10.1016\/j.jpedsurg.2003.09.041"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_009","doi-asserted-by":"crossref","unstructured":"McKenna, KM, Goldstein, RB, Stringer, MD. Small or absent fetal stomach: prognostic significance. Radiology 1995;197:729\u201333. https:\/\/doi.org\/10.1148\/radiology.197.3.7480746.","DOI":"10.1148\/radiology.197.3.7480746"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_010","doi-asserted-by":"crossref","unstructured":"Stringer, MD, McKenna, KM, Goldstein, RB, Filly, RA, Adzick, NS, Harrison, MR. Prenatal diagnosis of esophageal atresia. J\u00a0Pediatr Surg 1995;30:1258\u201363. https:\/\/doi.org\/10.1016\/0022-3468(95)90480-8.","DOI":"10.1016\/0022-3468(95)90480-8"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_011","unstructured":"Lacrampe, MJ, Jeanty, P. Polyhydramnios and small fetal stomach [online]. thefetus.net; 2002. Available from: https:\/\/thefetus.net\/content\/polyhydramnios-and-small-fetal-stomach\/."},{"key":"2026082107570339817_j_crpm-2025-0016_ref_012","doi-asserted-by":"crossref","unstructured":"Aguirre-Amezquita, F, Freeman, M, Tessier, K, Jones, C, Jacobs, KM, Cross, SN. Clinical outcomes associated with the sonographic finding of an absent or small fetal stomach [abstract]. Am J Obstet Gynecol 2021;224:S442. https:\/\/doi.org\/10.1016\/j.ajog.2020.12.728.","DOI":"10.1016\/j.ajog.2020.12.728"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_013","unstructured":"Payne, WA. Congenital absence of the trachea. Brooklyn Med J 1900;14:568."},{"key":"2026082107570339817_j_crpm-2025-0016_ref_014","doi-asserted-by":"crossref","unstructured":"Ashley, DJB. A case of congenital tracheal obstruction with esophageal atresia. J\u00a0Pathol 1972;108:261\u20133. https:\/\/doi.org\/10.1002\/path.1711080311.","DOI":"10.1002\/path.1711080311"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_015","doi-asserted-by":"crossref","unstructured":"Haight, C. Congenital atresia of the esophagus with tracheoesophageal fistula: reconstruction of esophageal continuity by primary anastomosis. Ann Surg 1944;120:623\u201352. https:\/\/doi.org\/10.1097\/00000658-194410000-00018.","DOI":"10.1097\/00000658-194410000-00018"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_016","doi-asserted-by":"crossref","unstructured":"Sankaran, K, Bhagirath, CP, Bingham, WT, Hjertaas, R, Haight, K. Tracheal atresia, proximal esophageal atresia, and distal tracheoesophageal fistula: report of two cases and review of literature. Pediatrics 1983;71:821\u20133. https:\/\/doi.org\/10.1542\/peds.71.5.821.","DOI":"10.1542\/peds.71.5.821"},{"key":"2026082107570339817_j_crpm-2025-0016_ref_017","doi-asserted-by":"crossref","unstructured":"Smith, MM, Huang, A, Labb\u00e9, M, Lubov, J, Nguyen, LHP. Clinical presentation and airway management of tracheal atresia: a systematic review. Int J Pediatr Otorhinolaryngol 2017;101:57\u201364. https:\/\/doi.org\/10.1016\/j.ijporl.2017.07.028.","DOI":"10.1016\/j.ijporl.2017.07.028"}],"container-title":["Case Reports in Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2025-0016\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2025-0016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:57:12Z","timestamp":1787299032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/crpm-2025-0016\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,8,24]]},"published-print":{"date-parts":[[2026,1,23]]}},"alternative-id":["10.1515\/crpm-2025-0016"],"URL":"https:\/\/doi.org\/10.1515\/crpm-2025-0016","relation":{},"ISSN":["2192-8959"],"issn-type":[{"value":"2192-8959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]},"article-number":"20250016"}}