Tracheoesophageal fistulas are due to congenital embryonic abnormalities that form a fistula between the trachea and esophagus. About half of the patients have other congenital anomalies such as cardiovascular, genitourinary and pulmonary insufficiency. Most of the cases are sporadic and only a few have a family history. The diagnosis of tracheoesophageal fistula is made on the basis of clinical manifestations, but the diagnosis is confirmed by X-ray. Laboratory tests show an increase in leukocytes in infected patients. Auxiliary tests: 1. Chest X-ray: The only X-ray signs of aspiration pneumonia are small patches of inflammation along the bronchial distribution, commonly in the middle and lower lung fields. In cases of chronic recurrent infection, small nodules or striae of increased density are seen. 2.Bronchography (iodine oil) and esophagography (iodine oil, barium): can help to clarify the site and morphology of the fistula. 3.Endoscopy: including fiberoptic bronchoscopy and esophagoscopy are used to help diagnose and localize the treatment. Newborns with tracheoesophageal fistula with esophageal atresia may present with choking and regurgitation of food and vomiting of pharyngeal secretions. Death is often rapid due to aspiration pneumonia and respiratory distress. The clinical presentation depends on the anatomic features and severity of the malformed lesion, with most presenting with choking and vomiting after feeding, prolonged recurrent lower respiratory tract infections, and occasionally hemoptysis.