<![CDATA[Background: Late referral of neonates with Gross type C esophageal atresia and distal tracheoesophageal fistula (EA/TEF) can be complicated by aspiration pneumonia and nutritional depletion. Objective: To describe physiological, nutritional, and surgical recovery in a late-referred term neonate with EA/TEF and reported symmetric intrauterine growth restriction. Methods: This longitudinal observational case study at Dr. M. Djamil General Hospital, Padang, Indonesia, covered inpatient and outpatient care from June 16 to August 11, 2025. Serial clinical, biochemical, and anthropometric measurements were described using percentage changes, oxygenation ratios, and growth velocity. The manuscript also reports Bradford Hill and Naranjo assessments; no within-patient inferential testing was performed. Results: A 7-day-old male neonate with a birth weight of 2,600 g presented with aspiration pneumonia, oxygen saturation of 88%, and weight loss to 2,200 g (15.38%). Stamm gastrostomy on hospital day 2, parenteral nutrition (84–110 kcal/kg/day), two albumin infusions (1.0 g/kg each), and trophic enteral feeding preceded weight recovery to 2,700 g. Thoracotomy, fistula ligation, and primary anastomosis were performed on day 17. Oral intake reached 280–320 mL/day by discharge on day 27, when weight was 2,955 g. Follow-up weight reached 3,700 g. Conclusion: This case describes recovery following staged decompression, nutritional support, and delayed repair. A single case cannot establish comparative safety, treatment efficacy, or causality.]]>
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