Obstruction In Newborn Infant Research Articles

Outcomes of neonates with congenital duodenal obstruction: A retrospective study

BackgroundCongenital duodenal obstruction (CDO) is a common cause of intestinal obstruction in newborn infants. There is limited information on growth and neurodevelopmental outcomes of infants with CDO. Recent studies have suggested that early commencement of enteral feeds facilitates early attainment of full feeds in surgical and very premature non-surgical infants. We aimed to describe the physical growth and one-year neurodevelopmental outcomes of infants with CDO, and to explore the association between time of commencement of enteral feeds and time to reach full feeds in CDO. MethodsRetrospective study (2002–2019). ResultsA total of 76 infants were included. The median gestational age was 37.2 w (range: 25.7 to 40.8). There were four deaths, not directly related to CDO. The mean Z scores for weight at birth was -0.39 (SD 1.05) vs -1.18 (SD 1.07) at discharge (p<0.0001). The mean Z scores for head circumference at birth was -0.04 (SD 1.21) vs -0.43 (SD 1.23) at discharge (p = 0.021). Adequate catch up growth occurred by one year. The median Development quotient (DQ) on Griffiths Mental Developmental Scales at one year among 41 non-syndromic infants was 100 (IQR: 94 to 107). On multivariable analysis, each day delay in commencing feeds was associated with 6% increase in time to reach full feeds (adjusted and exponentiated beta coefficient: 1.06; 95% CI: 1.02 to 1.09; p = 0.001). ConclusionsInfants with CDO had significant postnatal growth restriction during hospitalisation. Neurodevelopmental outcomes were reassuring. Early commencement of enteral feeds in the postoperative period may facilitate early attainment of full feeds. Level of evidenceLevel IV Prognostic study

Сучасні проблеми діагностики та лікування природженої обструкції дванадцятипалої кишки у новонароджених дітей (огляд літератури)

Сучасні проблеми діагностики та лікування природженої обструкції дванадцятипалої кишки у новонароджених дітей (огляд літератури)

Intraoperative placement of transnasal small intestinal feeding tube during the surgery in 5 cases with high position intestinal obstruction and postoperative feeding

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[ the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d). The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Estridor na sala de parto

OBJETIVO: Ressaltar a importância do estridor por anel vascular em recém-nascidos. DESCRIÇÃO DE CASO: Caso 1: recém-nascido a termo do sexo feminino, com história prévia de poli-hidrâmnio, apresentou estridor na sala de parto e necessidade de intubação orotraqueal com parâmetros ventilatórios moderados. Trouxe melhora do quadro respiratório após a inserçào de cânula traqueal além do habitual, o que motivou a investigação de compressão traqueal extrínseca. Realizado diagnóstico de duplo arco aórtico, seguido de cirurgia corretiva com boa evolução. Caso 2: menina de sete meses com estridor desde o nascimento e diagnóstico prévio de laringomalácia, com diversas internações anteriores por doenças respiratórias. Na última internação, houve melhora dos sintomas após a intubação seletiva do brônquio principal direito, sugerindo compressão extrínseca da traqueia. Após a confirmação do diagnóstico de anel vascular, foi submetida à correção cirúrgica, porém evoluiu a óbito. COMENTÁRIOS: O anel vascular não é a principal causa de estridor em recém-nascidos, mas deve ser considerado no diagnóstico diferencial. O baixo índice de suspeição dessa alteração leva a atrasos no tratamento e, como consequência, aumenta o risco de traqueomalácia e dismotilidade esofágica mesmo após a correção cirúrgica.

Fetal Duodenal Obstructions: Increased Risk of Prenatal Sudden Death

The most common form of bowel obstruction in newborn infants, with an estimated incidence of 1 in 10,000 live births, is congenital duodenal stenosis or atresia. Most often the second and third parts of the duodenum are affected. Outcomes have improved in recent years. The investigators looked at 29 fetuses given a prenatal diagnosis of duodenal obstruction and followed up prospectively from 1985 to 2000. Only three of these infants were identified in the second trimester; the mean gestational age at diagnosis was 29 weeks. Polyhydramnios was present in 24 cases (83%), and amniotic fluid was drained in half of them. Trisomy 21 was documented in six instances. About 60% of infants had other anomalies. One pregnancy was terminated, and there were four intrauterine fetal deaths at 31 to 35 weeks' gestation. Twenty-four infants were born alive, 10 of them delivered by cesarean. Signs of fetal distress were noted during labor in 29% of these cases. All but 2 of the 24 infants were operated on, most often undergoing duodeno-duodenostomy. One of the infants who did not undergo surgery died of heart failure, and the other lacked clinical signs of obstruction at birth. Three infants, all with associated anomalies, died postnatally. Two surviving infants had severe neurological impairment, and two others had impaired psychomotor development, Only six infants, 21% of the total, had a normal karyotype, no associated anomalies, and developed as normal neonates (Table 1). Prenatally diagnosed duodenal obstruction is a serious disorder. Even fetuses with a normal karyotype and no other anomalies are at risk of prenatal asphyxia and death. One possibility is that a distended upper gastrointestinal tract causes vagal overactivity and consequent bradycardia or asystole, resulting in fetal asphyxia.

Clinical Study of Congenital Duodenal Obstruction

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achievement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1 %), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13(33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.

Diagnostico por Doppler de la trombosis arterial causada por cateterismo umbilical

At her second day of life, a 2,200 g, 34 weeks gestational age female newborn infant with idiopathic respiratory distress syndrome, under treatment with mechanical ventilation and monitored through an umbilical arterial catheter (UAC), had severe clinical signs of arterial obstruction of her left limb. Signs of occlusion at the common femoral artery level were evident at Doppler ultrasonography. Doppler determinations showed early arterial blood flow improvement before amelioration of skin coloration and arterial pulses, that allowed close observation and withholding of surgical treatment which was finally not necessary. Eighteen newborn babies with an umbilical arterial catheter were then prospectively followed by Doppler ultrasound flow determinations. No further cases with clinical signs of arterial occlusion were found and Doppler studies performed in these late cases showed normal results in all of them. Doppler ultrasound flow determination is helpful for the diagnosis and management of lower limb arterial obstruction in newborn infants with umbilical arterial catheters.

Long-term experiences with carbamazepine (Tegretol) in children with seizures

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Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome.

Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.

Milk-Curd Bowel Obstruction in the Newborn Infant

IN 1969, Cook and Rickham1first reported a syndrome of neonatal intestinal obstruction due to inspissated milk curds. This new entity had not been seen before in more than 600 cases of bowel obstruction in newborn infants admitted to the Liverpool Neonatal Surgical Center and had not been previously described in the literature. They found that the obstruction occurred primarily in premature infants in whom high-caloric feedings were begun shortly after birth. In all eight cases, the babies were well at birth, passed normal meconium stools, and began receiving feedings of either reconstituted powdered milk or diluted milk-concentrate. Altered stools and then milk stools were passed until low small-bowel obstruction suddenly developed at ages 5 to 14 days. Studies indicated that milk-curd obstruction resulted from a combination of early feeding of high-caloric milk and the decreased ability of the infant to absorb proteins and amino acids. Of interest was

Micrognathia and glossoptosis in the newborn. Surgical tacking of the tongue in small jaw syndromes.

This report discusses airway obstruction in newborn infants with micrognathia and glossop tosis, and describes three patients who required surgical relief of obstruction from glossoptosis. In two, glossoptosis was controlled by construction of lingual-labial flaps under local anesthesia. The third required tracheostomy because of absence of the mandibular symphysis; to be effective, a lingual-labial flap requires a complete mandibular arch for support.The lingual-labial flap is the best surgical procedure for glossoptosis of the newborn. It can be constructed under local anesthesia in the nursery or in the operating room. It holds the tongue forward, yet it allows adequate tongue mobility for feeding. Composed of the patient's own tissues, it can remain for an indefinite time.

Persistent pulmonary vascular obstruction in newborn infants

Severe pulmonary vascular obstruction in the absence of obvious pulmonary parenchymal pathology was found in 5 full-term neonates and was characterized clinically by cyanosis and tachypnea. Cardiac catheterization and cineangiography at age 32 to 55 hours revealed pulmonary hypertension with right-to-left shunt through the ductus arteriosus in each instance. One infant died and autopsy revealed only a patent ductus arteriosus and marked medial hypertrophy of the muscular pulmonary arteries. Clinical resolution of pulmonary vascular obstruction occurred within 4 weeks in the survivors; this was confirmed in one infant by recatheterization. The possible causes of the persistence of pulmonary vascular obstruction are discussed.

Persistent pulmonary vascular obstruction in newborn infants

Persistent pulmonary vascular obstruction in newborn infants

Obstruction of the large bowel in newborninfants due to congenital bands

Summary 1. Two unusual cases of large bowel obstruction in newborn infants due to congenital bands extending from the undersurface of the liver to the hepatic flexure of the colon are presented 2. The similarity of the symptom complex to that found in adults with lesions obstructing the colon is discussed. 3. The early recognition of the possibility of such bands producingintestinal obstruction is emphasized.