Common GI Problems in Babies Dec 23,2011

GERD  Growing premie with frequent episodes of desaturation, apnea, bradycardia, cynosis  FT, baby, vomiting, some with FTT  Growing premie with frequent episodes of desaturation, apnea, bradycardia, cynosis  FT, baby, vomiting, some with FTT

Management  Position  Thickened formula with rice cereal  Meds:  H2 blocker: ranitidine, famotidine  Acid pump inhibitor:  Sphincter:  Gastric wall protection:  Position  Thickened formula with rice cereal  Meds:  H2 blocker: ranitidine, famotidine  Acid pump inhibitor:  Sphincter:  Gastric wall protection:

Tracheo-esophageal Fistula

TEF  “frothy secretion”  First feeding: choking, coughing, regurg  Pneumonia  Respiratory distress  Isolated or syndrome  “frothy secretion”  First feeding: choking, coughing, regurg  Pneumonia  Respiratory distress  Isolated or syndrome

 Polyhydramnio  Xray : shows OG,NG tube  Polyhydramnio  Xray : shows OG,NG tube

Pre-op  Prevent aspiration pneumonia; sump suction  NPO  r/o sepsis  2 D echo: VSD  Identify asstd malformation  Prevent aspiration pneumonia; sump suction  NPO  r/o sepsis  2 D echo: VSD  Identify asstd malformation

Post-Op care  End to end anastomosis  Paralyze patient x 7 days  Vent support: CPAP?  Nutritional support: TPN  Flouroscopy: prior to po feeds  Complication: GERD, stricture,poor motility, fistula tracheomalacia  End to end anastomosis  Paralyze patient x 7 days  Vent support: CPAP?  Nutritional support: TPN  Flouroscopy: prior to po feeds  Complication: GERD, stricture,poor motility, fistula tracheomalacia

Malrotation  Bilious vomiting in the first week of life

Pyloric stenosis  Non bilous vomiting: projectile  Failure to thrive  Hypochloremic metabolic alkalosis  Non bilous vomiting: projectile  Failure to thrive  Hypochloremic metabolic alkalosis

Pre-op Care  Correct fluid and electrolyte imbalance  Acid base imbalance  Post: feed patient PO once awake  Correct fluid and electrolyte imbalance  Acid base imbalance  Post: feed patient PO once awake

Abdominal Wall Defect  Polydramnio  Increased AFP  Polydramnio  Increased AFP

Gastroschisis  Viscera has no cover  Usually on the right  Viscera has no cover  Usually on the right

 Pre-op: silo bag  Prophylactic antibiotic  Pre-op: silo bag  Prophylactic antibiotic

omphalocoele  Covering of the viscera  As part of a syndrome  Covering of the viscera  As part of a syndrome

Intestinal atresia

Duodenal atresia

Imperforate anus

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