related to health of child

1. Ms. Chetna
Assistant Professor

3.  Composed of the nose, the pharynx, and the
larynx, the organs of the upper respiratory
tract are located outside the chest cavity.
 Nasal cavity: Inside the nose, the sticky
mucous membrane lining the nasal cavity
traps dust particles, and tiny hairs called
cilia help move them to the nose to be
sneezed or blown out.
 Sinuses: These air-filled spaces along side
the nose help make the skull lighter.

4.  Pharynx: Both food and air pass through the
pharynx before reaching their appropriate
destinations. The pharynx also plays a role in
speech.
 Larynx: The larynx is essential to human
speech.

5.  Composed of the trachea, the lungs, and all
segments of the bronchial tree (including the
alveoli), the organs of the lower respiratory
tract are located inside the chest cavity.
 Trachea: Located just below the larynx, the
trachea is the main airway to the lungs.

6.  Lungs: Together the lungs form one of the
body’s largest organs. They’re responsible for
providing oxygen to capillaries and exhaling
carbon dioxide.
 Bronchi: The bronchi branch from the
trachea into each lung and create the
network of intricate passages that supply the
lungs with air.
 Diaphragm: The diaphragm is the main
respiratory muscle that contracts and relaxes
to allow air into the lungs.

8.  Tracheo-oesophageal fistula and Oesophagal
Atresia are the malformation of digestive
system, In which oesophagus does not
develop properly. The oesophagus is a tube
that normally carries food from the mouth
to stomach.

9. Oesophagal Atresia
Oesophagal Atresia is the failure of
oesophagus to form a continuous passage
from the pharynx to the stomach.
Tracheo-oesophageal fistula
Tracheo-oesophageal fistula is an abnormal
connection between the trachea and the
oesophagus.

10.  Tracheo-oesophageal fistula occurs in 1 in 3500 births,
with slight male dominance.
 Approximately 50% of neonates with oesophagus
atresia or Tracheo-oesophageal fistula have other
anomalies also.
 Usually cardiac anomalies are seen in 14.7 – 28 % cases
of TEF.

11. CONGENITAL TEF
The cause of Tracheo-oesophageal
fistula and Oesophagal Atresia is
still unknown.

12. ACQUIRED TEF
Iatrogenic injury
Blunt chest or neck trauma
Prolonged mechanical ventilation via
endotracheal or tracheotomy tube

13. VATER
V- Vertebral defect
A- Imperforate Anus
T- Tracheoesophageal fistula
R- Renal dysplasia

14. VACTERAL
 V- Vertebral
 A- Anal
 C- Cardiac
 T- Tracheal
 E- Esophageal
 R- Renal
 L- Limb

15. Type A:Esophageal atresia without
fistula
In this type, there is Oesophagal Atresia
and proximal and distal segments of
oesophagus are blind. There is no
communication between trachea and
oesophagus. This type is present in 3-7
% of cases.

16. Types B: Esophageal atresia with
fistula
In this type, Oesophagal Atresia is
present and the blind proximal
segment of oesophagus connects
with trachea by a fistula. The distal
end of oesophagus is blind. This
type is present in 0.8 % cases.

17. Type C:Distel esophageal fistula
with atresia
In this type, Oesophagal Atresia is
present. The proximal end of
oesophagus is a blind pouch and
distal segment of oesophagus is
connected by fistula to trachea. This
is the commonest type, present in
about 87 % cases.

18. Type D:Proximal and distel
esophageal fistula with atresia
It is the rarest type that occurs in
0.7 % cases. In this type, both
upper and lower segments of
oesophagus communicate with
trachea.

19. Type E: H’ type
In this type, oesophagus and
trachea are normal and
completely formed but are
connected by a fistula.

20.  Three Cs
 Coughing
 Choking
 Cyanosis
 Apnea
 Increased respiratory distress during
feeding
 Abdominal distension

21. Ultrasound examination:- reveals
polyhydramnios, absence of a fluid-filled
stomach, a small abdomen, lower-than-expected
fetal weight, and a distended esophageal pouch.
Fetal MRI:- may be used to confirm the
presence of EA/TEF

22.  X-ray taken with radiopaque catheter placed in esophagus
to check for obstruction; standard chest X- ray shows a
dilated air-filled upper esophageal pouch and can
demonstrate pneumonia.
 Inability to pass a NG tube into stomach because it meets
resistance:;
 Bronchoscopy visualizes fistula between trachea and
esophagus;
 Abdominal ultrasound and echocardiogram to check for
cardiac abnormalities.

23.  The management of trachea-oesophageal
fistula is mainly surgical. Surgical
intervention depends on the distance
between proximal and distal pouch of
oesophagus, type of defect, condition of
neonate and his weight.

24.  If distance between upper and lower
oesophageal segments is less than 2.5 cm
 if the condition of infant is good, primary
repair is done by division and ligation of the
fistula along with end-to-end anastomosis of
proximal and distal segments of oesophagus.

28.  Pre-Operative
 Risk for aspiration related to structural
abnormality.
 Risk for deficient fluid volume related to
inability to take oral feeds.
 Impaired breathing related to frequent
laryngospasm and excessive secretions in the
trachea.

29.  Post-Operative
 Ineffective airway clearance related to disease
process.
 Impaired nutrition related to surgery.
 Altered comfort related to surgical process.

30.  A nasogastric tube is put in the upper
oesophageal segment and is aspirated frequently,
to prevent collection and aspiration of secretion
into the trachea.
 Intravenous fluids are administered to maintain
the hydration status of infant.
 Place the infant in semi-upright position and
administer oxygen if cyanosis is present.

31.  A cervical oesophagostomy is made to drain out
secretions from blind oesophageal pouch and
administer oxygen to infant.
 Feed the infant orally or by gastrostomy.
 Position the baby comfortably in semi-fowler’s
position and administer analgesics.

32.  Tracheomalacia (weakness of tracheal wall)
 Anastomotic leak (tension)
 Strictures (narrowing, esophageal dilation)
 Dysphagia (esophageal motility disorder)
 Respiratory distress
 Gastro-esophageal reflux.