Neonatal Emergencies Flashcards
What is a congenital diaphragmatic hernia?
A congenital diaphragmatic hernia is when the diaphragm does not form properly allowing herniation of abdominal organs.
More commonly occurs on the lt hand side and can occur at any stage of foetal development.
Why is congenital diaphragmatic hernias important?
They are important as they can be large and therefore may compress the developing lung buds stopping them from developing normally.
The baby may therefore go into respiratory distress.
How are congenital diaphragmatic hernias diagnosed and treated?
They are usually diagnosed antenatally.
Treatment involves intubation without bag and mask ventilation (as to not inflate the stomach) and to watch and wait for the first 48 hours.
If the neonate is stable enough then the abnormality is repaired surgically by a lateral thoractomy or abdominal approach.
What is oesophageal atresia?
It is when there is a malformed oesophagus so that it doesn’t connect to the stomach and/or forms a connection with the trachea known as a tracheo-oesophageal fistula..
How does oesophageal atresia present?
Baby not feeding feed.
Vomiting.
Lots of salivary secretions.
Respiratory distress particularly if there is a connection between the trachea and stomach.
How is oesophageal atresia treated?
Resus.
Surgical intervention to disconnect fistula and/or reconnect oesophagus and stomach.
Both are performed via a right lateral thoractomy.
What are the causes of neonatal bowel obstruction? (8, sort in to more/less/uncommon)
More common:
Necrotising enterocolitis
Hirschsprung’s disease
Less common: Small bowel atresia Duodenal atresia/stenosis Malrotation volvulus Meconium ileus Imperforate anus
Uncommon:
Prenatal perforation
What causes duodenal atresia?
Failure of gut canalisation.
Severity varies from a narrowed lumen to discrete atresic segments with different blood supplies.
Associated with downs syndrome
What are the symptoms of duodenal atresia causing bowel obstruction?
Pain
No stools
Vomiting (if the atresia is prior to the midpoint of the duodenum the vomit will not be bile stained)
What causes small bowel atresia?
It is caused by ischaemic involution by:
Thrombi-embolism
Volvulus
Intussusception
Treated by resus and surgical removal of atresia area.
What is necrotising enterocolitis and who is it more common in?
Is an infective condition causing necrosis of the bowel.
It is more common in premature babies and results from there immature guts not being able to top the translocation of gut flora.
How is necrotising enterocolitis treated?
Early recognition, triple antibiotic therapy and not to feed the child (allows the bowel to rest).
If the child remains unstable and/or suffers a complication (perforation or stenosis of bowel) then surgical intervention may be required to remove non functional bowel and restore continuity or create a stoma.
What is Hirschsprung’s disease and what causes it?
It is a disease in which part or all the small bowel has not developed peristaltic function.
It is caused by a defective nerve growth into the myenteric plexi of the bowel.
How does Hirschsprung’s present?
Most commonly presents with delayed passage of the meconium and with episodes of enterocolitis.
How is Hirschsprung’s diagnosed and managed?
Via a rectal biopsy.
Surgical removal of non functional bowel.
