Atresia of the esophagus: causes, symptoms and treatment

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2019-03-17 05:20:33

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According to the ICD, esophageal atresia is a congenital defect in development, which is characterized by partial or complete absence of the esophagus. This pathology is considered one of the most difficult in pediatric practice. If the newborn was diagnosed with this terrible affliction, it is urgent to undertake a surgical operation. Otherwise, the baby is guaranteed to die.

Child in hand

Esophageal Atresia in newborns is not as common. According to statistics, such disorders are born not more than 0.4% of children. This disease equally affects both boys and girls.

Helpful information

In some cases, the atresia is diagnosed in conjunction with other defects. For example, newborn can also be revealed pyloric stenosis, abnormalities of the limbs, problems with the anus, congenital heart disease and more. Also according to statistics, 40% of babies suffer from developmental problems or born prematurely. If the mother is carrying the baby with esophageal atresia, in the third trimester of pregnancy have a great risk of sudden abortion. It is therefore important to understand how to avoid this terrible disease, and is it possible to get rid of it.

Causes

Even at the time when the baby is just a tiny Bud, has to happen first stages of formation of the esophagus and other internal organs. Usually, this happens at 4-5 weeks gestation. To 12 weeks the esophagus are already fully differentiated. If in this period there are certain failures, the growth of the necessary cells slows down and produces esophageal atresia.

Such abnormalities can lead to a variety of factors. If a woman consumes alcohol, drugs and smokes, atresia may develop due to poor lifestyle of the expectant mother. Also the factors that cause a similar pathology, include a variety of events in the life of women. For example:

  • In the early stages of pregnancy was conducted x-ray studies.
  • Age of future mother is over 35 years old. The older a woman is, the higher the risk of developing anomalies. However, this problem may encounter and more young mothers.
  • Up To 12 weeks gestation the baby the woman took antibiotics teratogenic or embryotoxic action.
  • The Expectant mother lives in the conditions of bad ecology. In this case, the negative effect can be the presence of harmful components in the air, radiation, and more.
  • After conception the woman worked at a manufacturing plant, contact with chemicals or strong poisons.
  • One of the parents suffers from chromosomal abnormalities.
Child after birth

Very often in the formation of esophageal atresia in newborns of mothers is the risk of miscarriage. Typically, this occurs in the first trimester gestation of the baby. Also, the reason may be and polyhydramnios. In this case, the baby swallows the amniotic fluid.

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Varieties

Esophageal Atresia in children, just born, can be of different types depending on the affecting factors. For example, it may be completely absent in the lumen of the esophagus or it evolved in the form of two independent from each other blind bags.

In some situations the upper part of the essential organ has a blind end, whereas the lower area is connected by fistula with the trachea. In this case, the connection point falls on the place where the division into the bronchi.

There Are cases when the upper area of the esophagus ends blindly and the lower part goes straight into the windpipe. In other situations, the upper body connects with the trachea, and the lower area ends blindly.

Anomaly of the esophagus

Also, both sites of the esophagus may communicate with the trachea.

How does

Esophageal Atresia in children is detected almost immediately after their birth. The main symptom is that of the baby are strong frothy discharge from the nose and mouth. After the first breastfeeding the baby immediately spits up milk. This requires urgent parenteral nutrition. If the baby will not get the necessary nutrients intravenously, it will lead to its depletion and in dehydration.

When connecting the esophagus with the trachea main symptom is coughing, to the point that the baby begins to choke. Against this background, can quickly develop respiratory failure. In this case, you need as quickly as possible to clear the respiratory channels. After that will be noticeable improvement, but it only lasts until the next feeding. If in the lungs the gastric juice, it can lead to aspiration pneumonia. This is a very dangerous complication.

Also among the signs of esophageal atresia is to provide drastic weight loss, wheezing, and bluish skin of the newborn.

If the kid's body formed a fistula, it will lead to leakage of air directly to the incorrectly formed entity.

Mother andchild

All of these symptoms are very dangerous. Especially if the baby can not eat and the rejection of milk. In this case, on the background of dehydration may develop fever and respiratory failure. All this leads to death.

Diagnosis of esophageal atresia

If the doctor suspects the presence of this disease in this case are emergency measures to identify pathology. It is necessary to carry out the procedure vnutripuzarnogo sensing when the esophagus is introduced a flexible catheter. If the device will abut the blind end formed on incorrectly and comes out, it will be the most obvious proof that the baby really suffering from esophageal atresia. If the technician still remain a doubt, the further he enters into the esophagus air. If he with a loud sound starts to come out, then the diagnosis is confirmed.

Due to hardware bronchoscopic techniques can be used to visualize the blind end of the esophagus. This allows you to quickly determine the pathology and to prescribe possible treatment of esophageal atresia.

However, to finally confirm the diagnosis, some professionals prefer to be safe and injected into the body of the kid contrasting catheter. However, the suspension of barium is not always allowed to use. This may cause complicated breathing of the baby. Moreover, there is a great likelihood that a newborn simply will not survive this difficult procedure. In addition, contrast composition, which is used during this manipulation should be very quickly removed from the body of the baby. Otherwise it can get into lungs and cause chemical pneumonitis.

Recommended by the review of radiographs. Through this procedure it is possible to obtain a clear picture of the development of pathology. In addition, this method can be timely to install, and other anomalies that could develop with atresia. For example, in the research process can be revealed stenosis of the esophagus.

Additionally performed prenatal ultrasound. This procedure can reveal polyhydramnios, but it is not always a sign of development of this pathology. In some situations, the appearance of the symptoms associated with a completely other ailments. Also, thanks to ultrasound can reveal is missing if the baby gastric bubble is more than 50%.

Child in hospital

After all these measures, if the diagnosis is confirmed, it is necessary to proceed to immediate action.

Treatment

First and foremost, doctors should try to stabilize the condition of the baby. To do this, they avoid mask ventilation. At this stage, we must do everything possible to prepare the newborn for surgery. Thus, the first is pre-operative care, then surgical intervention. If the procedure is successful, the required postoperative events.

Care before surgery for esophageal atresia

During the preoperative preparation it is necessary to stop feeding the baby through the mouth. Allowed only intravenous feeding. In addition, doctors have to continuously suck the accumulating saliva from the upper part of the esophagus. This helps to prevent aspiration. This procedure uses a special catheter with double lumen.

Suction can be done in two methods. In the first case, a special catheter is placed in the blind pouch located in the upper part of the esophagus. After that it is connected to a pump, which operates without interruption.

The Second method involves the use of suction drainage. This method is considered the best, as in the event there is no risk of damage to the mucous membranes.

It is important to make sure the baby's head was constantly raised by 30-40 degrees. Best to lay him on his side. This will greatly simplify the emptying of the stomach and will reduce the potential risk of what will happen aspiration of gastric secretion. In addition, in this position, the baby will be much easier to breathe.

Baby yawn

If the baby was stabilized and the doctors are ready to perform the operation in this case is made extrapleural correction in which a tracheoesophageal fistula closes. In some particularly complex situations, the specialists inserted into the colon additional segment of the esophagus.

Postoperative events

If experts managed to improve the condition of the baby and get rid of atresia of the esophagus after surgery, you will need to carefully monitor vital signs of the newborn. To do this, the physician must constantly be aware of the indicators of a ventilator.

Additionally installed special wound drainage. Also in the baby's body will be of a gastric tube with the required marks. It in no event it is impossible to remove, as this device is necessary for the normal patency of the anastomosis.

After surgery for atresia of the esophagus is very important to monitor the position of the baby. It should be on the back, under the neck you need to put a small cushion. The upper body should be on a smallelevation. This is not to prevent gastroesophageal reflux. The baby's head should be fixed in the middle position and ensure that her newborn baby did not turn. You also need to avoid pulling the neck. The area of the anastomosis should not be under pressure.

If on the third day after surgery the baby is in stable condition, you can start to lay on its side. But you first must consult with a specialist, who has previously performed the operation.

In addition, it is important to continuously monitor newborns undergoing major surgery. A doctor should always be aware of the number, color and consistency of secretions passing through the drainage. If the liquid begins to turn a greenish hue, in this case, the anastomosis may become insolvent.

Gastrostomy Care

If the atresia is characterized by great length or unstable condition, in this case, a primary anastomosis may not be necessary. In such situations, imposed a gastrostomy. It uses a special balloon catheter of the type that led into the stomach of the baby through the hole in the abdominal wall.

In the next step the catheter is blocked and fixed by a roller of the tampon. You will also need to connect the receiver.

To Change the catheter must after three weeks. Usually by this point in the accretion of the walls of the peritoneum and stomach. However, the special suction drainage, which is connected to aspiration equipment, should still be in the upper area of the operated esophagus. In this case, the probe must be made of flags that allow to avoid the formation of bedsores.

Small child

If the kid feels well, it is possible to consult with the surgeon to commence enteral nutrition.

Possible complications

Of Course, this kind of pathology and surgery at the age of several days do not always go unnoticed. Among the most frequent consequences of esophageal atresia in newborns can distinguish acute complications, which occur in the form of leaks in areas of the anastomosis. As a result, can form a stricture.

As after surgery of the distal segment of the esophagus is unable to fully function, it leads to serious problems while feeding the baby. Similar effects are found in 85% of cases. The defect of this kind is due to gastroesophageal reflux. In this situation, you may need additional correction. However, in some cases it is ineffective. Then the doctor may try to Nissen.

Among the consequences of esophageal atresia almost always observed hoarseness in the newborn. This state can last quite a long time, up to one year. This is because during the operation the laryngeal nerve is damaged. To avoid this almost impossible.

In addition, after surgery, the baby may develop pneumonia, mediastinitis, and anemia. In some cases, the little patients are very difficult to swallow food. On the background of complications may also develop esophagoscopy.


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Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."

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