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Neonatal Emergencies

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Neonatal Emergencies

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    1. Neonatal Emergencies

    2. “Neonatal bilious emesis is a surgical emergency until proven otherwise”

    7. INCARCERATED INGUINAL HERNIA Most common in first year of life 30% of infant hernias present with incarceration most manually reducible Dx by physical examination alone If abdomen distended or septic obtain KUB to R/O free air

    8. MECONIUM ILEUS Most commonly diagnosed at birth 1/3 of neonatal small intestinal obstructions Occurs in 15% of infants with CF Extremely rare in non-Caucasians Males and females equally affected

    9. MALROTATION Must consider in every infant with bilious emesis Many subtle variations of malrotation/ nonfixation 30% present within first week of life 50% within first month Midgut volvulus with necrosis disasterous Can lead to SBS, intestinal tx, death

    10. HIRSCHSPRUNG’S ENTEROCOLITIS Major cause of morbidity / mortality Commonly misdiagnosed as gastroenteritis No known etiology or effective prevention Occurs in 1/3 Presenting sx - 7.7%; Postop - 21% Higher incidence of enterocolitis associated with early dx, (especially first week of life): definitive repair <4 mo of age

    11. Pyloric Stenosis

    12. Pyloric Stenosis Most common GI obstructive anomaly in neonates Hypertrophy of the muscular layer of the pylorus A medical emergency but not a true surgical emergency Incidence: 1 – 3 :1,000 live births 2 - 5x more common in first born, M > F (4:1)

    13. Pyloric Stenosis Etiology : unknown ? acquired condition with hereditary predisposition Symptoms are apparent between 2nd-6th wk of life Presents with nonbilious projectile vomiting, signs of dehydration, jaundice (2%)

    14. Pyloric Stenosis Physical Exam visible gastric peristalsis palpable “olive-shaped” mass to the right of the epigastric area signs of dehydration Labs: CBC serum electrolytes EKG ABG BUN

    15. Pyloric Stenosis Diagnosis history and physical exam abdominal ultrasound upper GI series with barium contrast not recommended pathological pyloric wall thickness = 4 mm pyloric length of > 16 cm

    16. Pyloric Stenosis

    17. Pyloric Stenosis Preoperative Preparation

    18. Pyloric Stenosis Surgical Management Pyloromyotomy definitive treatment open or laparoscopic Lab indices for safe anesthesia serum Cl >100 mEq/L HCO3 < 28 mEq/L

    19. Congenital Diaphragmatic Hernia

    20. Congenital Diaphragmatic Hernia

    21. Congenital Diaphragmatic Hernia 50% mortality regardless of the method of treatment Incidence: 1:2,000-5,000 live births M<F 1:1.8, frequently full term Etiology: unknown no genetic factors have been implicated Antenatal history: polyhydramnios

    22. Congenital Diaphragmatic Hernia

    23. Congenital Diaphragmatic Hernia

    25. Congenital Diaphragmatic Hernia

    28. Congenital Diaphragmatic Hernia

    30. Congenital Diaphragmatic Hernia Intraoperative

    32. Tracheoesophageal Fistula

    33. Tracheoesophageal Fistula

    40. Abdominal Wall Defects

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