ALIMENTARY TRACT OBSTRUCTION IN THE NEWBORN INFANT

Abstract

From this discussion and analysis of 132 cases of congenital obstruction of the alimentary tract, several conclusions can be drawn: A challenge still exists for a further reduction of the mortality rate of the newborn with congenital anomalies of the alimentary tract. This challenge can be met only by early diagnosis and treatment. There is a gradual increase in the number of newborn infants with congenital alimentary tract anomalies being seen and treated at the Children's Orthopedic Hospital each year. Eighteen per cent of infants with atresia of the alimentary tract have additional areas of obstruction. A predominance of males was noted in those infants with Hirschsprung's disease and jejunal and ileal atresia, while a predominance of females was found in those infants with imperforate anus. Infants with anal malformations and alimentary tract atresia exhibit the highest incidence of associated congenital anomalies (31.2% to 75.0%). The groups of infants with meconium ileus and esophageal and duodenal atresia had the greatest incidence of prematurity (12.5% to 38.5%). In infants with anal malformations, there is found a 68% incidence of rectal fistulae of one type or another. Infants with anal malformations have the best prognosis, while infants with meconium ileus and those with multiple lesions, have the poorest. Temporary gastrostomy, when used after primary repair of esophageal atresia, appears to be of distinct benefit. In the majority of instances the diagnosis can be established by the aid of a single plain roentgenogram of the abdomen. This should be done routinely in any case of a newborn infant who has persistent vomiting and/or abdominal distention.