According to the ICD, esophageal atresia is a congenital developmental defect characterized by a partial or complete absence of the esophagus. This pathology is considered one of the most difficult in pediatric practice. If the newborn has been diagnosed with this terrible ailment, an urgent surgical operation is necessary. Otherwise, the baby is guaranteed to die.
Esophageal atresia in newborns is not so common. According to statistics, with such a pathology, no more than 0.4% of children are born. In this case, the ailment equally affects both boys and girls.
Useful information
In some cases, atresia is diagnosed in conjunction with other malformations. For example, in a newborn, pyloric stenosis, abnormal limb development, problems with the anus, congenital heart disease, and much more can also be detected. Also, according to statistics, in 40% of cases, babies suffer from developmental problems or are born prematurely. If the mother wears a baby with esophageal atresia under the heart, then in the third trimester of pregnancy there is a high risk of abortion. Therefore, it is important to figure out how to avoid this terrible ailment, and whether there is an opportunity to get rid of it.
Causes of occurrence
Even at the moment when the baby is only a small germ, the first stages of the formation of the esophagus and other internal organs are already taking place. As a rule, this happens already at 4-5 weeks of gestation. By week 12, the esophagus is already completely differentiated. If this or that malfunction occurs during this period, then the growth of necessary cells slows down and atresia of the esophagus forms.
A variety of factors can lead to such an anomaly. If a woman uses alcohol, drugs and smokes, then atresia may well develop due to the wrong lifestyle of the future mother. Also, the factors that cause a similar pathology include a variety of events in the life of a woman. For instance:
- In the early stages of pregnancy, x-rays were performed.
- The future mother is over 35 years old. The older the woman, the higher the risk of developing anomalies. However, younger mothers may face a similar problem.
- Until the 12th week of gestation, the woman took antibiotics of teratogenic or embryotoxic action.
- The future mother lives in a bad environment. In this case, the presence of harmful components in the air, radiation exposure and much more can have a negative effect.
- After conception, a woman worked at a manufacturing plant in contact with chemicals or strong poisons.
- One of the parents suffers from chromosomal pathology.
Very often, before the formation of atresia of the esophagus in newborns, mothers are at risk of miscarriage. As a rule, this occurs in the first trimester of bearing a baby. Polyhydramnios may also be the cause. In this case, the child swallows amniotic fluid.
Varieties
Esophageal atresia in children who have just been born may be of different types, depending on the damaging factors. For example, the lumen of the esophagus may be completely absent or it may develop in the form of two blind bags that are independent of each other.
In some situations, the upper part of the vital organ has a blind end, while the lower zone is connected by a fistula along with the trachea. In this case, the connection point falls on the place where the division into the bronchi occurs.
There are cases when the upper zone of the esophagus also ends blindly, and the lower part goes straight into the trachea. In other situations, the apex of the organ is connected to the trachea, and the lower region ends blindly.
Also, both sections of the esophagus can communicate with the trachea.
How does it manifest
Esophageal atresia in children is detected almost immediately after they are born. The most important symptom is that the baby has strong foamy discharge from the nose and mouth. After the first breastfeeding, the baby immediately spits up milk. In this case, emergency parenteral nutrition is required. If the baby does not receive the necessary nutrients intravenously, this will lead to its depletion and dehydration.
When connecting the esophagus with the trachea, the main symptom is a strong cough, up to the point that the baby begins to suffocate. Against this background, respiratory failure can develop quite quickly. In this case, you need to clean the respiratory canals as soon as possible. After this, an improvement will be noticeable, however, it lasts only until the subsequent feeding. If gastric juice enters the lungs, this can lead to aspiration pneumonia. This is a very dangerous complication.
Also, among the signs of esophageal atresia, it is worth highlighting a sharp weight loss, wheezing and bluishness of the skin of the newborn.
If a fistula has formed in the baby's body, this will lead to air entering directly into the malformed organ.
All these symptoms are very dangerous. Especially if the baby cannot fully eat and milk is rejected. In this case, against the background of dehydration, fever and respiratory failure may develop. All this is fatal.
Diagnosis of esophageal atresia
If the doctor suspects the presence of this terrible ailment, then in this case emergency measures are taken to identify the pathology. For this, it is necessary to carry out the procedure of intranasal sounding when a flexible catheter is inserted into the esophagus. If the device abuts against the blind end of an irregularly formed organ and comes out, this will be the most obvious evidence that the baby really suffers from atresia of the esophagus. If the specialist still has doubts, then he additionally introduces air into the esophagus. If he starts to go out quickly with a loud sound, then the diagnosis is confirmed.
Thanks to hardware bronchoscopic methods, it is possible to obtain an image of the blind end of the esophagus. This allows you to quickly determine the type of pathology and prescribe a possible treatment for atresia of the esophagus.
However, in order to finally verify the diagnosis, some specialists prefer to play it safe and insert a contrast catheter into the baby’s body. However, barium suspension is not always allowed to be used. This can lead to difficulty breathing baby. Moreover, there is a great likelihood that the newborn simply will not tolerate this complex procedure for him. Among other things, the contrast composition that is used during this manipulation should be very quickly removed from the baby's body. Otherwise, it can enter the lungs and cause chemical pneumonitis.
A survey radiograph is recommended. Thanks to this procedure, you can get the most clear picture of the development of pathology. In addition, thanks to this method, it will be possible to timely establish other anomalies that could develop with atresia. For example, during the study, stenosis of the esophagus can be detected .
In addition, prenatal ultrasound is performed. Thanks to this procedure, polyhydramnios can be detected, however, it is not always a sign of the development of this pathology. In some situations, the appearance of this symptomatology is associated with completely different ailments. Also, due to ultrasound, it is possible to detect whether the baby has a gastric bladder by more than 50%.
After all these measures, if the diagnosis is confirmed, it is necessary to proceed with immediate measures.
Treatment
First of all, doctors should try to stabilize the baby's condition. To do this, they avoid mask ventilation. At this stage, everything possible must be done to prepare the newborn for surgery. Thus, first of all, preoperative care is performed, after which surgical intervention is performed. If the procedure was successful, then postoperative measures are required.
Care before surgery for esophageal atresia
During preoperative preparation, it is necessary to stop feeding the baby through the mouth. Only intravenous feeding is allowed. In addition, doctors must continuously aspirate accumulating saliva from the upper part of the esophagus. This helps prevent aspiration. For this procedure, a special catheter equipped with a double lumen is used.
Suction can be carried out by two methods. In the first case, a special catheter is placed in a blind bag located in the upper part of the esophagus. After that, it is connected to the suction, which works without interruption.
The second method involves the use of suction drainage. This method is considered the best, since in the process of these measures there is no risk of damage to the mucous membranes.
It is important to ensure that the baby's head is constantly raised by 30-40 degrees. It’s best to lay it on its side. This will greatly simplify gastric emptying and reduce the possible risk of gastric secretion aspiration. In addition, in this position, the baby will be much easier to breathe.
If the baby was able to stabilize and the doctors are ready to perform the operation, then in this case an extrapleural surgical correction is performed, during which the tracheoesophageal fistula is closed. In some particularly difficult situations, specialists insert an additional segment of the esophagus into the large intestine.
Postoperative measures
If specialists managed to improve the condition of the baby and get rid of atresia of the esophagus, after surgery, it will be necessary to carefully monitor the vital signs of the newborn. To do this, the doctor must constantly be aware of the indicators of mechanical ventilation.
Additionally, a special wound drainage is installed. Also in the baby’s body there will be a gastric tube with the necessary marks. In no case can it be removed, since this device is necessary for the normal patency of the anastomosis.
After surgery for atresia of the esophagus, it is very important to monitor the position of the baby. It should be on the back, a small roller should be placed under the neck. The upper body should be at a slight elevation. In this case, gastroesophageal reflux should not be allowed. The baby's head needs to be fixed in the middle position and make sure that the newborn does not turn it. Neck stretching should also be avoided. There should not be pressure on the anastomosis zone.
If the baby is in a stable condition on the third day after surgery, then it can begin to be laid on its side. However, you must first consult with a specialist who previously performed the operation.
In addition, it is important to constantly monitor the newborn who has undergone serious surgery. The doctor should always be aware of the quantity, color and consistency of the discharge passing through the drainage. If the liquid begins to stain in a greenish tint, then in this case the anastomosis may prove to be insolvent.
Gastrostomy Care
If atresia is long or unstable, then in this case, the initial application of an anastomosis may not be required. In such situations, a gastrostomy is superimposed. For this, a special balloon-type catheter is used, which is inserted into the baby’s stomach through an opening in the abdominal wall.
At the next stage, the catheter is blocked and fixed using a swab of tampons. You will also need to connect the receiver.
Change the catheter after three weeks. As a rule, by this moment there is already a fusion of the walls of the peritoneum and stomach. However, the special suction drainage, which is connected to the suction equipment, should still be in the upper zone of the operated esophagus. At the same time, marks are necessarily made on the probe to avoid the formation of pressure sores.
If the baby feels satisfactorily, then it is possible to consult with the surgeon regarding the beginning of the introduction of enteral nutrition.
Possible complications
Of course, such pathologies and operations at the age of several days do not always go unnoticed. Among the most frequent consequences of esophageal atresia in newborns, acute complications can be distinguished, which are manifested in the form of leakage at the sites of the anastomosis. As a result, a stricture may form.
Since after the surgical intervention, the distal segment of the esophagus cannot fully function, this leads to serious problems during feeding the baby. Similar effects occur in 85% of cases. A defect of this kind is explained by gastroesophageal reflux. In this situation, additional correction may be required. However, in some cases, it is ineffective. Then the doctor can try to conduct Nissen fundoplication.
Moreover, among the consequences of atresia of the esophagus, hoarseness of the voice in a newborn is almost always noted. This condition can last quite a long time, up to one year. This is because during the operation, the nerve of the larynx is damaged. Avoiding this is almost impossible.
In addition, after surgery, the baby may develop pneumonia, mediastinitis and anemia. In some cases, it is very difficult for small patients to swallow food. Against the background of complications, esophagoscopy may also develop.