What is the most likely explanation for a newborn that is drooling, choking, and coughing with bubbles at the mouth?

The symptoms of drooling, choking, and coughing with bubbles at the mouth in a newborn are most indicative of tracheoesophageal fistula (TEF). This congenital condition involves an abnormal connection between the esophagus and the trachea, which can lead to the aspiration of saliva and feeding materials into the airway.

When a newborn has a TEF, any fluid that enters the esophagus can spill into the trachea instead of properly moving into the stomach. This results in coughing, choking, and the presence of bubbles or frothy saliva at the mouth due to the mixing of air with secretions. The excessive drooling observed in the newborn can result from an inability to swallow saliva properly and the presence of fluid accumulating in the mouth.

The timing of the symptoms, particularly if these were observed shortly after birth, supports the diagnosis of a TEF, which generally manifests soon after a newborn begins to feed. Understanding these specific clinical signs allows healthcare providers to recognize the potential urgency of the condition and the need for immediate intervention.