Tracheal esophageal fistula accounts for early feeding difficulty in neonates. A proximal esophageal atresia with a fistula between the lower esophageal pouch and the airway is the most common variant. The initial workup includes an ECHO cardiogram as well as screening for other associated abnormalities. Operative intervention is needed to separate the esophagus from the airway and restore esophageal continuity. Common postoperative complications include esophageal leak, recurrent fistula, and anastomotic stricture.