Surgical Congenital Anomalies Research Articles

Antenatal Diagnosis and Genetic Counseling

Antenatal diagnosis plays a major role in management of surgical problems of the fetus. Diagnostic testing in the antenatal period offers parents the option of avoiding the physical suffering and emotional trauma that may occur during the birth of a child with a severe, debilitating illness. Along with diagnosis, a good antenatal counseling reduces parents' stress and assists them to prepare for the hardship of a complicated pregnancy. Various medical and surgical anomalies involving wide range organ systems can be diagnosed antenatally. Antenatally diagnosed congenital surgical anomalies are usually first brought to the notice of the obstetrician who decides the fate of the fetus. Eighty percent of these fetuses are terminated at the level of the obstetrician. These include anencephaly, neural tube defects, polycystic kidneys, gastroschisis and omphalocele where the decision is unequivocal. On the contrary these also include few cases of minor anomalies like unilateral multicystic kidney, unilateral hydronephrosis and cleft lip where the decision of a pediatric surgeon would be to continue the pregnancy. There seems to be a huge scope for fetal therapy and this seems to be particularly possible in certain surgical conditions which are easily accessible with risk of fetal mortality being less (eg. abdominal wall defects). Antenatal diagnosis of various surgical conditions like abdominal wall defects and diaphragmatic abnormalities (eg. Congenital diaphragmatic hernia - CDH) allows early planning of management by a group of specialists including obstetricians, neonatologists, pediatric surgeons, and geneticists. This article discusses various aspects of antenatal diagnosis and counseling, focusing on the surgical aspects along with current status of fetal therapy for various surgical conditions.

Long-term nutritional assessment of patients with esophageal atresia and/or tracheoesophageal fistula

Fifty-three patients operated for esophageal atresia and/or tracheoesophageal fistula at the Childrens Hospital of Los Angeles returned for long-term nutritional assessment. The ages ranged from 11 months to 31 years of age with a mean age of 9 years 11 months. Nineteen percent of the patients were below the third percentile in height for their age, thus exhibiting evidence of chronic malnutrition. No significant differences could be demonstrated between patients with a birth weight above or below 2500 g or above or below 5 years of age. Patients over 13 years of age demonstrated considerably less evidence of chronic malnutrition (p less than .06), thus exhibiting a "catch-up" growth phenomenon. Associated anomalies and illnesses were frequently seen in patients with the most significant abnormal nutritional-assessment parameters. Nutritional assessment should be part of long-term management and follow-up of all patients with esophageal atresia or other congenital surgical anomalies.