Neonatal surgical emergencies

1. Oesophageal atresia and TOF
   Presentation
   • may have antenatal history of polyhydramnios
   • may have excessive oral secretions (blows saliva bubbles)
   • if no TOF may have scaphoid abdomen
   • atresia without TOF may present later
   • TOF without atresia presents later with airway/ chest problems

Diagnosis
• Insert NGT (meets resistance)
• CXR with NGT in situ shows coiled NGT at the level of atresia

Management
• NPO
• Place baby in a 30 degree head up position
• Start iv fluids, abx
• Suction, if possible continuous of excessive secretions
• Urgent surgical review
• Look for other anomalies
  (vertebral, anal, cardiac, tracheal, eosophageal, renal, limb anomalies - VACTERL)
2. Intestinal atresia
   usually small bowel, duodenum, jejunum or ileum
   Presentation
   • bile stined vomiting
   • degree of abdominal distension depends on level of atresia
   
   Diagnosis
   • usually gaseous distension on xray depending on level of obstruction, with no distal bowel gas
   • may pass some meconium
   • duodenal atresia: double bubble on abdominal Xray. Look for possible downs syndrome
   
   Management
   • refer for urgent surgery after rescuscitation

3. Necrotizing enterocolitis
   Due to intestinal ischaemia, common in premature babies
   Presenation
   • vomiting, abdominal distension then abdominal wall erythema, palpable abdominal mass and blood and mucous per rectum
   
   Diagnosis
   • AXR (supine and erect) shows thickened bowel wall and intramural gas
   
   Management
   • NPO
   • NGT for free drainage, iv fluids
   • Abx
4. Gastroschisis
   Abdominal wall defect next to umbilicus, bowel is not covered.

   Management

   • At delivery NEVER WRAP EXPOSED BOWEL IN SALINE SOAKED GAUZE. But cover with a clean or sterile polythene bag. It is possible to put whole trunk of baby in a plastic bag.
   • Keep warm
   • NPO, NGT on open drainage, IV fluids, Abx
   • Put on left side to reduce traction on the bowel mesentry
   • Urgent surgical review. Outcome best when operated within 24 hours post partum
5. Other neonatal surgical conditions

Cleft lip and palate

• unilateral or bilateral, complete or incomplete, lip and /or palate
• look for associated abnormalities (midline cleft always associated with syndrome)
• support mother with breastfeeding (palatal cleft may require expressed breast milk via NGT of cup and spoon)
• aims of medical care are to support feeding to ensure that the baby is fit for later surgical repair. Cleft lip at 3 months and cleft palate at 9 months

Spina bifida

• document head circumference and do full neurological examination
• if small defect, normal neurological examination and no other associated abnormalities present
  • start Abx
  • paint with GV paint and cover lesion
• if neurological signs
  • uss head