This newborn had feeding difficulty and respiratory distress after birth. A chest x-ray is shown above. The oro-gastric tube tip is consistent with a location in the right lower lobe bronchus. There is consolidation of the right lung. There is gas in the intestinal tract. The findings are consistent with a double tracheo-esophageal fistula or an H-type fistula. Exploration and surgical correction demonstrated a double tracheo-esophageal fistula.