Introduction Embryological malformation in a newborn with distal esophagus arising from trachea proximal esophagus ending in a blind pouch Can be part of a broader constellation of findings called VACTERL association associations are seemingly unrelated malformations that occur together Presentation Symptoms difficulty feeding inability to swallow pneumonia aspiration of stomach contents into lungs maternal polyhydramnios fetus cannot swallow amniotic fluid for reentry of fluid into vasculature Physical exam associated VACTERL syndrome findings Vertebral abnormalities Anal atresia Cardiac defects TE fistula Renal disease Limb abnormalities Treatment Surgical correction