Neonatal surgical emergencies

What are Neonatal surgical emergencies?

There is presence of congenital anomalies requiring emergency surgical management in infants following their birth. It is important to recognise and treat them within few days after birth, else they can be life-threatening. These conditions are known as Neonatal surgical emergencies. Earlier, these malformations are recognised and treated, better are the chances of successful outcomes. 

What are the types of Neonatal surgical emergencies?

There are mainly three types of Neonatal surgical emergencies, namely:

What is Congenital diaphragmatic hernia (CDH)?

Congenital diaphragmatic hernia (CDH) is the birth defect of the diaphragm (muscle that separates chest from the abdomen) where it fails to close during the prenatal development. As a result of this, the contents of the abdomen migrate through this hole into the chest and prevent the lungs from growing to normal size. After the baby is born, if the lungs are not of sufficient size, then the baby may not be able to provide itself with enough oxygen to survive. It is a life-threatening condition.

The signs and symptoms of CDH include: Difficulty breathing, fast breathing, fast heart rate, bluish coloured skin, abnormal chest development (one side is larger than other) and abdomen that appears caved in.

The treatment for CDH involves surgical repair- Fetoscopicendoluminal tracheal occlusion (FETO).

What is Tracheoesophageal fistula (TEF)?

Tracheoesophageal fistula (TEF) is a birth defect that occurs when the fetus is still in the womb. In TEF, an abnormal connection is formed between the esophagus and trachea. In such cases, the food in the esophagus can move to trachea and the air in trachea can move into the esophagus. This can create many complications for the baby.

The signs and symptoms of TEF include: Frothy, white bubbles in the mouth, coughing/choking while feeding, vomiting, bluish skin, difficulty breathing and very round full abdomen.

TEF can be treated by recognising and treating its underlying cause. Some common treatments methods for TEF are: Medications, stenting, pulmonary support and surgical repair. 

What is Necrotizing enterocolitis (NEC)?

Necrotizing enterocolitis (NEC) is condition in infants where the tissue in the inner lining of the small or large intestine gets damaged and begins to die resulting in inflammation of the intestine. It usually affects the inner lining of the intestine but the whole mass can also get affected. In serious conditions, a hole is formed in the wall of intestine through which bacteria present in intestine can easily pass to the abdomen and cause infection. This calls for medical emergency.

The signs and symptoms of NEC include: Swelling/bloating of abdomen, discoloration of abdomen, bloody stool, diarrhea, poor feeding and vomiting.

The treatment for NEC depends on the severity of the condition in the baby that may include: Stopping breast feeding, giving fluids and nutrients intravenously, antibiotics and breathing assistance. In severe cases, surgery may be required to remove damaged intestine. 

What is Malrotation?

Malrotation is a medical condition that occurs in early pregnancy where the infant’s intestine do not form into a coil in the abdomen and result in obstruction or blockage. Surgery is needed to repair this birth defect.

The signs and symptoms ofMalrotation include: Yellow or green colour vomiting on frequent basis, swelling in abdomen, pale colour, loss of appetite, little or no urine, infrequent bowel movements, blood in stool, fever and lethargy.

Malrotation is a medical emergency that requires surgical operation “Ladd’s procedure” to be done to move infant’s intestine

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