With the development of neonatal, monitoring, anesthesia and surgical techniques, the success rate of surgery and long-term survival rate are getting higher and higher, but the problem is that children who have a successful surgery can have normal breast milk or formula and do not have to worry about nutrition. But what about the nutrition of children who fail the first surgery and need to undergo multiple surgeries? The current reality in China is that most of the children who undergo surgery are still type III esophageal atresia and very few are type I or staged, which is related to national conditions and health insurance. Weight and the presence of cardiovascular anomalies are two important factors in the preoperative risk classification of children with esophageal atresia. Thus, weight, which implies developmental status, implies nutritional status, and also has a serious impact on the prognosis of treatment. Low weight, malnourished children have poor healing capacity, low resistance, susceptibility to infection and increased chance of anastomotic fistula (no specific statistics are available). The first surgery for type III esophageal atresia is important, and the occurrence of anastomotic fistula after surgery is a serious complication, followed by severe thoracic and mediastinal infections, pulmonary atelectasis, difficulty in withdrawing the ventilator, adhesions, anastomotic stenosis and even reattachment, leading to surgical failure. Whether treated conservatively or aggressively with re-surgical repair, the nutritional problems of the child are particularly prominent during this procedure. Parenteral nutrition (intravenous nutrition) and enteral nutrition (placement of nasogastric tube, gastrostomy tube, jejunal feeding tube) are commonly used. Total intravenous nutrition is not the best choice for newborns, and the prominent symptoms are intolerance such as jaundice and abnormal liver function due to cholestasis, as well as impaired intestinal mucosal barrier function and high price are its shortcomings. Enteral nutrition is a nutritional support that provides nutrients via the gastrointestinal tract. The biggest advantage is that when there is food passing through the intestine, it helps to improve the circulation of the portal system, improve the blood perfusion and oxygen supply to the relevant organs in the abdominal cavity, especially the intestine; enhance intestinal peristalsis; promote the release of intestinal hormones and immunoglobulins; facilitate the growth of intestinal mucosal cells, improve the permeability of the intestinal mucosa, maintain the function of the intestinal mucosal barrier, and reduce the intestinal Bacterial endotoxin translocation. Enteral nutrition includes: (1) transoral enteral nutrition (i.e., oral ingestion or swallowing of liquid meal); (2) transductal enteral nutrition (i.e., the liquid meal enters the gastrointestinal tract far from the oral cavity, or referred to as tube feeding). Commonly used tube feeding techniques are as follows: 1, nasogastric (intestinal) tube nasogastric (intestinal) tube feeding can be used as a transitional treatment of total parenteral nutrition to oral feeding, which is conducive to reducing the complications of total parenteral nutrition. The advantage of nasogastric tube feeding is that the volume of the stomach is large, the osmotic pressure of the nutrient solution is not sensitive, and it is suitable for the application of the elemental diet, homogenized diet, mixed milk enteral nutrition support, but the disadvantage is the risk of reflux and aspiration of the trachea, therefore, for patients with abnormal gastric emptying or severe esophageal reflux, the feeding tube should be placed through the nose into the duodenum distal to the pylorus or proximal jejunum to give feeding. 2, gastrostomy Gastrostomy is a catheter placed directly into the stomach to provide feeding or implement decompression. Because of the storage capacity of the stomach, osmotic pressure regulation, prolonged intestinal delivery, and the convenience of stoma access and flexible nutritional input, gastrostomy is currently the preferred route of postoperative nutritional infusion in children with esophageal atresia. However, in patients with inadequate gastric motility, there is impaired emptying, reflux, and aspiration by mistake. 3, jejunostomy The most commonly used clinical enteral nutrition support is jejunostomy feeding route, the advantages of which are less vomiting and aspiration caused by liquid diet reflux, which is one of the most prone to serious complications of enteral nutrition; enteral nutrition support and gastroduodenal decompression can be carried out simultaneously; feeding tube can be placed in the intestine for a long time, which is suitable for patients who need long-term nutrition support. (iv) Endoscopic percutaneous gastrostomy, percutaneous gastro/enterostomy (PEG, PEG/J): not suitable for neonatal esophageal atresia. In children with esophageal atresia who have failed a single surgery, both nasogastric tubes and gastrostomy show their obvious shortcomings: children with esophageal atresia have more or less poor gastrointestinal motility, so that gastroesophageal reflux due to impaired gastric emptying not only causes delayed healing of the anastomotic leak, but also leads to vomiting, choking, aspiration by mistake and even asphyxia. Therefore, for children with esophageal atresia, a gastrostomy with a jejunal feeding tube or a gastrostomy with a nasogastric tube is recommended to facilitate early postoperative enteral feeding. This can be used not only as a regular postoperative nutritional route, but also as a backup route (especially gastrostomy with jejunal feeding tube) to supplement children with recent postoperative esophageal strictures. For children with a failed first surgery and anastomotic leak, it is even more significant: ensuring nutrition means ensuring the effectiveness of reoperation or conservative treatment, breaking the vicious circle, promoting healing, shortening the course of the disease, improving the prognosis and reducing costs. Increase confidence and patience!