B. Scaphoid abdomen- Diaphragmatic hernia- EA without TEFC. Excessive mucus & salivation- EA with/ without TEFD. Abdominal distention- Pneumoperitonium Causes are : NEC, bowel wall ischemia, instrumentation, TEF
E. Vomiting:1. Bilious emesis : Can be a life threatening emergency 20% require immediate surgical interventionCauses:- Malrotation with/ without volvulus- Duodenal/jejunal/ileal/colonic atresias
- Most difficult of all neonatal emergencies- Most common site is left hemithorax.- Incidence 1 : 4000 live births- Associated with trisomies 13 & 18, 45 XO Goldenhar syndrome, Backwith- Wiedmann synd. Pierre robin synd. Goltz-Gorlin synd. Rubella synd.
• Symptoms : - Cyanosis at birth - Respiratory distress - Scaphoid abdomen - Decreased / absent breath sounds on hernial side - Shift of cardiac sounds opposite to the hernia
• Diagnosis: 1. Antenatal diagnosis – - Often undetected as it occurs mostly after 16 wks. - Presence of liver in the thorax asso with increased severity & poor prognosis
2. Postnatal diagnosis:X ray : cardiothymic shift- loops of bowel in the chest- mediastinal shift- absent lung markings
• Treatment: - Immediate intubation - Bag & mask is contraindicated - immediate NG tube insertion & continuous suction. - Low pressure ventilation - to avoid damage to contra lateral lung. - Surgical repair with reduction of intestine into abdominal cavity.
Extracorporeal Membrane Oxygenation (ECMO)• Use: controversial• Allows the lungs to develop & restructure• Expensive
Criteria for ECMO• Gestational age ≥ 34 wks• Weight ≥ 2000 grams Predicted mortality ≥ 80%
Clinical Findings• High type : – A flat perineum & lack of a midline gluteal fold – Absence of an anal dimple• Low type : – the presence of meconium at the perineum, – A bucket-handle malformation – Anal membrane (through which meconium is visible).
Skeletal System :• Partial or complete lumbosacral agenesis• Hemivertebrae• Agenesis of thoracic vertebrae• Scoliosis• Hemisacrum or scimitar sacrum• Asymmetric sacrum• Posterior protruding sacrum• Agenesis of the coccyx
Outcome after surgery• Altered bowel habits in most of the cases• 50% - few episodes of accidental soilage• Few of them require major adjustments in lifestyle secondary to fecal incontinence, chronic constipation, and odor.
Physical Exam distended and tender abdomenLabs: CBC electrolytes and glucose platelets and coagulation profile DIC profile ABG
Abdominal X-ray• signs of bowel obstruction• Ileus with edematous bowel• Pneumatosis intestinalis or intramural air (arrow)• Air in portal vein• pneumoperitoneum
Medical Management • No enteral feedings for 10-14 days • NGT on intermittent suction • Hydration and correction of electrolytes • Ventilatory support • Antibiotics • Blood and platelet transfusion if needed