A newborn is suspected of having esophageal atresia with tracheoesophageal fistula (TEF). Which clinical finding would most strongly support this diagnosis?

A. Excessive oral secretions, coughing, and cyanosis during feeding is correct. These are classic signs of esophageal atresia with tracheoesophageal fistula (TEF). TEF results in an abnormal connection between the trachea and esophagus, causing ingested fluids to enter the airway. This leads to choking, coughing, cyanosis, and excessive drooling, especially during feeding. Early recognition is critical to prevent aspiration and respiratory complications. B. Poor suck reflex and hypotonia is incorrect because these findings are associated with neurologic or metabolic disorders, not TEF. While feeding difficulties may occur, they do not specifically indicate a fistula between the trachea and esophagus. C. Projectile vomiting with blood-tinged emesis is incorrect because this is more characteristic of pyloric stenosis or upper gastrointestinal bleeding, not TEF. TEF primarily affects swallowing and airway protection, not gastric emptying. D. Bilious vomiting with abdominal distension is incorrect because these signs suggest intestinal obstruction, such as malrotation or intestinal atresia, rather than TEF.