Effects of an operation on the intestines of a newborn


Intestinal paresis in newborn infants

Why can there be a pathology in a newborn baby?

The main reason for the development of intestinal paresis in infants is a violation of the formation of the autonomic nervous system in the uterine period. Violation of the formation of the nervous system can be due to the influence of many factors. During pregnancy the organism of the future mother can be subject to stress. Taking medications, especially in the first trimester. Deficiency of vitamins and microelements in the body of a pregnant woman. Viral and chronic diseases during pregnancy have a negative impact on the formation of the nervous system of the baby's future. Abuse of bad habits of a future mother: smoking, alcohol. Incomplete rest, absence of walks in the open air, inadequate food. Birth trauma can also cause the development of intestinal paresis in a newborn baby.

Self-recognition of the disease in a baby can be determined by certain features in the early days of his life. But sometimes the symptoms of

an intestinal paresis can appear several days after birth.

A newborn has a bloating. Absence of gases and stools, but in some cases a baby can have a watery stool and gases. The baby experiences discomfort in the abdomen, which is accompanied by crying and restless sleep. The chair of the child becomes irregular. Possible nausea and bouts of vomiting. Sometimes a newborn has an increase in body temperature. Bleeding during paresis of the intestine in a breastfed child begins rarely. In general, this symptom indicates a complication in the form of peritonitis and other diseases.

Diagnosis of intestinal paresis in a newborn

Diagnosis can be made by a doctor at an external examination of the baby, as well as after receiving the results of the research. With paresis of the intestine, the baby's abdominal circumference increases. On this basis, the doctor will be able to determine the severity of the disease. For the diagnosis, the doctor examines the abdomen of the baby by palpation, and also listens for noise in the intestines with a stethoscope. At a paresis of an intestine of a noise it is audible badly or completely absent. A newborn child is sent for X-ray examination. An ultrasound examination of the abdominal cavity may be prescribed. To assess the general condition of the baby, a general blood and urine test is administered.

What is dangerous for a newborn baby?

The danger of intestinal paresis is the possible development of intestinal obstruction. Due to bloating, the diaphragm is displaced and the internal organs squeezed. This can cause the development of tachycardia, shallow breathing in a newborn baby. Frequent attacks of vomiting are dangerous for the development of dehydration, which is very dangerous for a newborn baby and can lead to death. If the treatment of intestinal paresis in a newborn baby is started in time, then usually the prognosis is favorable without the development of dangerous complications in the future.

What can you do

Self-management of the disease in the infant is not possible. At the first sign of a paresis of the intestine in a newborn baby, parents should consult a doctor. The doctor will prescribe a treatment that must be strictly adhered to. To reduce the unpleasant sensations in the intestines and to remove gases, you can briefly spread the newborn to the stomach. Some experts recommend putting the baby's belly on the knee of an adult, thereby helping to escape the gases. Light strokes on the abdomen and motion sickness help to relax the baby. Of great importance is the nutrition of the mother, who feeds the baby with the breast. Through breast milk, a baby can get substances that cause the formation of gas. Therefore, nursing mothers should not eat foods and drinks that cause gas formation in a newborn baby.

What the doctor does

To cure the disease in a newborn baby, the doctor prescribes a series of studies. After receiving the results, treatment will be prescribed to restore intestinal motility and metabolic processes. Intravenous infusion therapy is prescribed, as well as the introduction of a gas outlet rectal tube and naso-gastric intubation. To facilitate the condition of the newborn baby, the doctor can prescribe a course of massage. Massage helps in restoring intestinal motility and reduces pain in the abdomen. Also, the administration of medications intended to reduce gassing in the intestines, designed specifically for the newborn, may be prescribed. At elevated body temperature, antipyretic drugs are prescribed. In severe cases, if complications arise, surgical intervention may be prescribed. But surgery is usually not carried out for newborn babies.

Specific prevention to prevent disease does not exist.

The future mother should take care of her health, regularly visit doctors for the timely detection of pathologies. During pregnancy and breastfeeding, mother must adhere to proper nutrition, regularly walk outdoors, fully rest. Pregnant women should avoid stressful situations, and do not take medications without consulting a doctor. When viral diseases occur, timely treatment is necessary. If a future mother has chronic diseases, she should avoid complications and undergo medical examinations. Also, during pregnancy and breastfeeding, you should forget about bad habits.

My baby was born prematurely 02.04., Gestation period 25 weeks weight 700 g. For the period of life until 06.06. no pathology of development was identified. By the indicated date the weight of the child was 1750 gr. we were in the department of pathology of newborns, ate and grew. Since May 30, my daughter began to suck her breasts.

06.06. at 3.00 my daughter became ill, her stomach swelled, she cried a lot and much. At 7.00 I was informed that based on pictures, analyzes, etc. my girl is supposedly NEC. According to one of the strongest local surgeons there was a paresis of the intestine. According to the third version, the cause of gas generation and pain was bacteria. And according to the experience of the resuscitator, this is definitely an operation.
The operation began at 16.30 on the basis of its results, a diagnosis was found of the curvature of the intestines due to twisting of the mesentery, two stomas were withdrawn. From the words of the surgeon, everything was untwisted and straightened. And now it remains only to wait for the restoration of blood circulation in the small intestine affected by ischemia. Despite all our prayers, a miracle did not happen, the state of the daughter deteriorated and 08.06. the second operation was made. The cavity, as a result of which the necrotic area of ​​the intestine was removed with the application of anastomosis. From the small intestine the child has: duodenum, 10 cm lean and 5 cm ileal.
1. Is such an intestine viable, is it possible to preserve the functions of suction of food and under what conditions.
2. What are the compensatory capabilities of the organism of a child born with extremely low weight? Is it possible to grow the intestine to the minimum necessary size for a full life or at least life on an exclusively enteral diet?
3. What are the operations for lengthening the intestine and at what age do they do?
4. Is the normal life of the child and family possible in our situation, or is the syndrome of the small intestine inevitable?
5. What is the life expectancy of such children?
6. Where can we apply for treatment, if, of course, you have information about the clinics specializing in our problem.

Read also

Congenital malformations of the digestive tract in newborns. page 9

The main diagnostic method for suspected high intestinal obstruction is X-ray examination, which begins with an overview radiograph in the vertical position in two projections. A typical radiologic symptom of a complete high KH (atresia of the duodenum) is the presence of two gas bubbles with fluid levels (a symptom of a double bubble) and the absence of gas in the lower intestine (Fig. 6). Such an x-ray picture absolutely surely confirms the diagnosis of high SC, and therefore no additional methods of research (including using contrast agents), not are required.

Fig. 6. Atresia of the duodenum. There are 2 gas bubbles with fluid levels and no gas in the lower intestine.

With duodenal stenosis or a membrane with an opening (partial duodenal obstruction), a small amount of gas is sometimes seen on the radiographs distal duodenum, with a characteristic radiographic evidence of duodenal obstruction (a double-bladder symptom) may absent. A similar x-ray picture is also observed with partial intestinal obstruction caused by the annular pancreas (Fig. 7).

Fig. 7 Ring-shaped pancreas. There are 2 gas bubbles and poor gas filling of the distal parts of the intestine.

In this case, it is necessary to carry out contrast research and, first of all, to exclude the syndrome maltreatment, which radiographically and clinically may resemble a partial duodenal obstruction. However, with malorotation (in contrast to the malformations of duodenum itself), in case of untimely diagnosis, life-threatening complications resulting from the turn of the mid-gut may develop. Therefore, after the survey radiographs to determine the position of the colon in the abdominal cavity perform irrigography in a direct projection. For irrigography in newborns, we apply a 25-30% solution of veroprograph, which is prepared immediately before the examination by diluting in -3 times 76% of the solution of contrast medium. To fill the entire colon in full-term newborns (the first days of life), 45-60 ml contrast agent, in preterm infants - 25-30 ml (at the rate of approximately 15 - 20 ml per kg of body weight body).

With the correct location of the large intestine in the abdominal cavity (in the form of a horseshoe), the diagnosis of malrotation syndrome with a turn in the middle gut may be excluded. In this case, in order to clarify the diagnosis, it is necessary to carry out a study of the passage of the contrast medium along the digestive tract, With this purpose, after washing the barium suspension from the large intestine, 15-20 ml of iodolipol or sulphate barium. Delayed evacuation of contrast medium from the stomach for 2 hours and appearance on radiographs made in a vertical position, two levels in the projection of the stomach and the initial department of the duodenum confirms the diagnosis of duodenal obstruction.

Almost all patients with high KH require preoperative preparation, which can last as long as required the state of the child, since in this pathology, life-threatening complications usually do not arise, requiring urgent surgical assistance. It is necessary to normalize the biochemical composition of the blood (electrolytes, bilirubin, sugar, etc.), CBS, completely eliminate the symptoms of exsicosis. Calculation of the volume of fluid for infusion therapy and the qualitative composition of infusate is the same as in children with pyloric stenosis (see Fig. higher).

The operation of choice in children with high KH with duodenal atresia and annular pancreas is duodenoduodenoanastomosis, with the membrane of the duodenum - membranectomy. If the obstruction in the duodenum is located near the Treetz ligament, duodenojunoanastomosis is imposed, since the creation of duodenoduodenoanastomosis in this situation is impossible.

The choice of the method of surgical correction is determined by the need to maximize the recovery of normal anatomy of the affected area, which is especially important for a growing organism. Therefore, with high KH, newborns and young children should not undergo an operation that is often performed in adult patients, namely, gastrojejunoanastomoz, in spite of the fact that this intervention is technically more simple than duodenoduodenoanastomosis or duodenojunoanastomoz. No matter how well gastrojejunoanastomosis was applied, however, the left blindly terminating loop of the duodenum as the child grows rapidly increases in size, which can be the cause of severe dyspeptic disorders (heaviness in the abdomen, frequent eructations, recurring vomiting, stagnant contents, etc.).

At any kind of surgical intervention in newborns, we try to provide early initiation of enteral nutrition, especially in connection with our very modest capabilities of a long-term balanced parenteral power supply. To do this, during the operation for duodenal obstruction, we put two probes: one into the stomach for decompression, the other into the jejunum (beyond the anastomosis zone) to introduce the nutrient mixture. The gastric gavage is left open for constant removal of stagnant contents from the stomach, and through the intestinal probe for 3 days postoperative period, we begin the introduction of a nutritional formula (adapted milk formula, breast milk) micro-jet with a small speed (with 2 ml / hour). As the patient's condition improves, the speed of the microfluidic administration is increased. When restoring the passage through the intestine (as indicated by the cessation of stagnation in the stomach, the appearance of a stained stool), we begin feeding into the stomach, while reducing the volume of milk introduced into the gut. Duodenoduodenoanastomosis begins to function, as a rule, on the 6-7th day of the postoperative period. By 8 - 10 days usually it is possible to transfer the patient to full enteral feeding through the mouth and remove the intestinal probe.

Sources: http://detstrana.ru/service/disease/newborns/parez-kishechnika/, http://klubkom.net/posts/105010, http://vunivere.ru/work6906/page9


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