What should you consider in a child with difficulty feeding
- ? cleft palate
- CHD - signs of resp distress/infection
- Dysmorphia
- Hypotonia - neuromuscular conditions
- oesophageal or choanal atresia
What position may a baby make with hypotonia
from leg position
How does unilateral coanal atresia present
- noisy breathing
- feeding difficulties
- choking
How does bilateral choanal atresia present
cyanosis at birth when not crying
they have to breath through their mouth
passing a NGT bilaterally without idfficulty would rule this out
What is choanal atresia
congenital disorder where the back of the nasal passage is blocked - abnormal bony or soft tissues
What is the management of choanal atresia
stent
What is oesophageal atresia
blind ending oesophagus
can involve a fistulae communicating between esophagus and trachea - tracheoesophageal fistula
What other conditions is oesophageal atresia associated with
- VACTERL
- CHARGE syndrome
- Trisomies 13/18/21
- Others: DiGeorge/Fanconi/Pierre-Robin
What is VACTERL
- vertebral defects
- anorectal malformation
- CV defects
- tracheo-oesophageal defects
- Renal abnormalaties
- Limb defects
What is CHARGE syndrome
- Coloboma
- Heart defects
- Atresia choanae
- Retarded development
- Genital hypoplasia
- Ear abnormalaties
What is coloboma
gap in iris, usually at the bottom of the eye, think Maddie McCann
What features would you expect to see on antenatal scan in a foetus with oesophageal atresia?
maternal polyhydramnios
small or absent fetal stomach bubble
- sensitivity of 50%
What is the post-natal presentation of oesophageal atresia
- first few hours of life
- respiratory distress
- choking
- feeding difficulties
- frothing at the mouth
Investigations for oesophageal atresia
- inability to pass NGT
- If passes into a blind end pouch it curls up and can be seen on CXR
Management of oesophageal atresia
surgical repair which usually involves ressecting the fistula
next step will depend on the gap between the stomach and oesophagus
Post operative complications of oesophageal atresia
- anastomotic leak
- stenosis at anastomotic sight
- oesophageal dysmotility
- GORD
Common causes of polyhydraminios
- idiopathic 50%
- GI anomalies
- skeletal dysplasia
- fetal neuromuscular conditions
- renal anomalies
- trisomy 13/18/21
- maternal diabetes
- multiple pregnancy
- fetal anaemia
congenital infections - hydrops fetalis
What GI anomalies impair fetal swallowing
oesophageal atresia
duodenal atresia
congenital diaphragmatic hernia
Why can skeletal dysplasia cause polyhydramnios
insufficent thoracic space to facilitate oesophageal development
Which congenital infections can lead to polyhydramnios
- parvovirus B19
- rubella,
- cytomegalovirus
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Infections/Fever76
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