Neonatal surgical emergencies
Nowadays, 15% of neonatal deaths are caused by conditions that can be cured by surgery. These conditions fall into neonatal surgical emergencies.
Some emergencies such as:
- Osophageal atresia: (no food pipe)
- Congenital diaphragmatic hernia (hernia through defective diaphragm)
- Intestinal atresia (intestinal obstruction)
- Malotation of the intestine (abnormal twisting of the intestine)
- Incomplete anus (no anal opening)
The esophagus is the food pipe that connects the mouth to the stomach. In this condition, there is no part of the esophagus. Due to the lack of connection, the food / nutrition coming from the mouth never reaches the stomach.
Symptoms of Oesophageal Atresia:
Newborns with oesophageal atresia have difficulty swallowing their own saliva. Therefore, they accumulate saliva in the back of the mouth. Other common features:
- The bluish color of the skin
- Choking or coughing while eating
- Difficulty in breathing
- Excess saliva in the baby’s mouth
Diagnosis of oesophageal atresia:
Without careful examination, ossophageal atresia can be difficult to detect. If
saliva accumulation is observed in the newborn , a catheter (small tube) is inserted into the stomach through the food pipe. If the catheter is obstructed, esophageal atresia is diagnosed. Furthermore, X-rays are indicated to gather information about what is missing from the esophagus.
Treatment of oesophageal atresia:
Once oesophageal atresia is diagnosed, some precautionary measures are followed. Often by suction, the upper part of the esophagus is left empty. The baby’s head is raised to 30 degrees (approximately) to reduce the reflux of saliva. After precautionary measures, surgery is performed to connect the sections of the esophagus.
Congenital diaphragmatic hernia
The diaphragm is a flat muscle that separates the chest from the abdomen. In the early stages of fetal development, the thoracic (thoracic) and abdominal parts move freely. In the later stages of development a diaphragm is formed between them. Sometimes, the development process of the diaphragm is interrupted and a hole is formed in the diaphragm. Abdominal organs such as the stomach and intestines push themselves through the hole, a condition known as congenital diaphragmatic hernia. Depending on the location of the hole one or both sides of the chest are affected. Hernia puts pressure on the lungs and prevents their growth. Due to the incomplete growth of the lungs, the amount of oxygen needed for survival is not supplied. Therefore, this condition can be fatal to the baby.
Symptoms of congenital diaphragmatic hernia:
Symptoms of congenital diaphragmatic hernia may vary depending on the pressure on the lungs. The symptoms of the condition are not easily detected and therefore the malignancy cannot be diagnosed carefully. Features:
- Cyanosis (bluish discoloration of the skin)
- Indigestion (difficulty breathing)
Diagnosis of congenital diaphragmatic hernia:
A newborn with this condition has an increased heart rate. On further investigation, it was found that the affected side of the chest was moving less compared to the other side. Occasionally, different sounds may be heard from the chest. X-ray reveals in-depth details about the hernia in the chest. Treatment of congenital diaphragmatic hernia: Surgical reduction of the hernia is the recommended treatment for this condition. Even if there are few or no symptoms, surgery is indicated because the condition can be fatal to the baby.
The small intestine is made up of three main parts: the duodenum, the jejunum, or the ileum. The small intestine is the link between the stomach and the large intestine and it plays an important role in digestion. Intestinal atresia is an abnormal constriction or obstruction in the small intestine. The blockage can occur in any part of the small intestine. Intestinal obstruction usually occurs in singles, but can also occur in multiples. Intestinal atresia interferes with the digestive process and is fatal to the baby’s life.
Symptoms of Intestinal Atresia:
It is common at birth for children born with this condition. However, after some time or especially after eating, the symptoms shown are:
- Vomiting with bitterness
- Abdominal distention or swelling
Diagnosis of Intestinal Atresia:
The doctor may prescribe the following diagnostic tests to confirm the presence of intestinal atresia:
- X-ray or ultrasound of your baby’s abdomen
- Upper gastrointestinal (GI) test
- Low gastrointestinal examination
Imaging studies of the heart and kidneys are sometimes performed to check for abnormalities along with intestinal obstruction.
Treatment of Intestinal Atresia:
Surgery is the most preferred treatment for intestinal atresia. The surgeon will make an incision in your baby’s abdomen and remove the affected part of the bowel, taking care to keep the bowel as healthy as possible. The surgeon then reconnects the intestines if necessary.
Degeneration of the intestine
This condition occurs during pregnancy. In the early stages of intestinal development, they develop into a small and simple tube. However, as they continue to grow, they will rot in the abdomen. In some cases, the baby’s bowels do not turn. Babies born with this condition may have other ancillary conditions:
- Disorders of the digestive system
- Heart defects
- Abnormalities of other organs, including the spleen or liver
Maltration of the intestines can lead to the following problems:
- Volvulus: In which, the intestine twists itself and damages the blood supply to the tissues, leading to tissue death.
- Bands of Load: In this condition, tissue bands form in the small intestine, which block the first part of the intestine from the rest of the intestine.
Teams of Volvulus or Ladd become a threat to the baby. Therefore, immediate treatment of this condition is very necessary.
Symptoms of intestinal abuse:
This condition can interfere with the passage of food. Features:
- Abdominal pain
- Abdominal cramps
- Inflammation of the abdomen
- Diarrhea and / or blood in the stool
- Feeling sad or crying
- Rapid heart rate and respiration
- There is little or no pee due to fluid loss
Diagnosis of bowel abuse:
To confirm bowel abuse, the following tests are performed:
- Computed tomography (CT) scan
- Abdominal ultrasound
Treatment of intestinal abuse:
Surgery is the only treatment for bowel abuse. The timing of the surgery is determined by the baby’s condition.
The nasogastric (NG) tube is inserted through the nose into the stomach and intestines. It cleanses the intestines and stomach contents.
Ladd’s bands take care of the intestines by straightening and splitting Ladd’s bands. Then the bowel folds properly.
During surgery, the baby’s appendix is also not removed.
If the child is ill during the surgery, an ileostomy or colostomy procedures are performed on the child. In this, the diseased part of the intestine is removed and the healthy part of the intestine is brought to open the abdominal skin to remove the waste products from the body. This is a temporary condition that can be removed later depending on the extent of the bowel.
Surgeries to correct bowel abuse have a successful rate.
This condition develops during the fifth to seventh week of pregnancy. In this condition, the baby develops the anus properly and thus does not defecate from the rectum. The causes of incomplete anus are unknown. It is more common in boys than in girls. This is a serious condition and infants need immediate treatment / surgery.
Symptoms of Incomplete Anus:
Incomplete anus can be detected immediately after birth by physical examination. Symptoms of Incomplete Anus:
- No anal opening
- Improper anal opening such as being too close to the vagina
- No stool in the first 24 to 48 hours of life Defecation through the wrong place like urethra or scrotum.
- Inflammation of the abdomen is a fistula (abnormal connection) between your baby’s rectum and their reproductive system or urinary tract.
Many babies with incomplete anus have other problems such as kidney and urinary tract defects, spinal abnormalities, defects in the windpipe, and esophageal defects.
Diagnosis of Incomplete Anus : A physical examination is performed to diagnose incomplete anus. Further tests are indicated to confirm the presence of other abnormalities.
Prescribed tests: X-ray: Detection of bone abnormalities Ultrasound: MRI to detect spinal abnormalities: Echocardiogram to detect esophageal defects or defects in the windpipe or trachea: Incomplete anal surgery always requires surgery for incomplete anus. The timing and urgency of the surgery depends on the condition of the baby. A colostomy is performed to temporarily remove fecal matter from the body. The pediatrician will determine any corrective surgery by taking into account factors such as how far the baby’s rectum has descended, how the nearby muscles are affected, and the presence of a fistula.
In anoplasty (to create the anal opening, or to pull the rectum into the anal opening), the fistulas are closed so that the rectum does not attach to the urethra or vagina. An anus with a normal position is then created.
A pull-through procedure is performed to pull the rectum down and connect it to the new anus.
A procedure called anal dilatation is performed to prevent the anus from narrowing. This procedure needs to be performed periodically and the pediatrician will train the parents accordingly.
Giggles’ pediatrics department at OMNI, Visakhapatnam has state-of-the-art equipment and state-of-the-art technology to manage surgical emergencies in newborns. Giggles Vizag by OMNI is the best pediatrician who specializes in performing surgeries and related problems.