Intestinal atresia refers to a bowel obstruction that is caused by the abnormal development of the bowel. This blockage can occur in both sections of the small intestine, either the jejunum or the ileum. Even though this condition affects only about 0.1% of live births, a third of those diagnosed with intestinal atresia are premature. Infants with low birth weight also have a higher chance of developing this condition.
Symptoms of intestinal atresia
This condition is often detected within a few days of birth. This is because the child will likely not have passed meconium (first stool). Though the newborn will feed normally, they will slowly appear dehydrated because of frequent vomiting. Their belly may also appear swollen. Other symptoms include a low fever, rapid heartbeat and blotchy skin. Sometimes infants with intestinal atresia may also present with jaundice.
Causes of intestinal atresia
Intestinal atresia is a congenital condition (present at birth). This occurs because of a loss in blood supply in the section where the intestine is closed off.
Risks of intestinal atresia
For infants who have a large part of the small intestine missing, either because of underdevelopment in the womb or the need to remove a large section during surgery, they may develop short bowel syndrome. This means that they need to be dependent on intravenous (IV, through the vein) nutrition for a longer time. The greater dependence on IV nutrition is because there is not enough surface area in the remaining intestine to absorb adequate nutrients.
In most other cases of intestinal atresia, however, it is possible for a full recovery after surgical repair.
Dealing with intestinal atresia
Intestinal atresia is can be corrected with surgery. The procedure will involve removing the obstruction and repairing the bowel so that it is functional again. Depending on the number and type of obstruction, multiple surgeries may be required.
Before and immediately after the surgery, you baby will need to be given nutrition through an IV tube. This method of feeding is referred to as total parenteral nutrition (TPN). Once their digestive tract is able to handle formula, they may be switched to enteral feeding, before being able to feed normally through the mouth. Their bodily waste will also need to be drained from the digestive tract through a stoma. This refers to a surgically created opening that connects the digestive tract to the abdominal wall. An ostomy care system is attached to the stoma to drain the bodily waste.
Once the NICU team decides that your baby is ready for discharge, you may be required to continue enteral feeding for your child, as well as gastric drainage. These should continue until the bowel has had time to heal completely.
Medical homecare equipment explained:
- Infusion Pump
An infusion pump is a device that administers controlled dosages of fluids and or medication. The flow rate can be adjusted as required. This pump can be connected to an IV tube that has been placed in vein in the hand, foot or scalp of the baby. It can also be connected to a peripherally-inserted central catheter (PICC) line that is usually inserted near the elbow. This pump enables parents to continue TPN at home.
- Feeding Pumps
This device regulates the amount and flow of nutrition and medicine that goes from the feeding bag into the baby’s feeding tube. Feeding that is done using this device can either be continuous (done over 8-24 hours) or done several times throughout the day (bolus method). Your doctor will advise you on the frequency at which you need to feed your child. Every time you set up the machine for your child, ensure that the supplies are clean, and are handled with clean hands.
This feeding pump can be used with various enteral feeding tubes, which include nasogastric tubes (runs through the nose, through the oesophagus and into the stomach), gastrostomy tubes (runs from the abdominal wall to the stomach, commonly known as g-tubes) and enterostomy tubes (runs from the abdominal wall to the intestines).
- Ostomy care system
If your child returns home with a stoma, you will need to begin using an ostomy care system. This system mainly comprises of a bag for waste collection, and a baseplate that connects the bag to the stoma. While the NICU staff or your medical equipment specialist will go through with you on how to use the system, it is important to note that special care must be taken to avoid damage to the skin around the stoma. Particular attention has to be paid when replacing the bag.
The stoma also has to be kept clean. Gently cleanse with water every time you change the bag. Do check with your doctor or your medical equipment specialist on the kind of products (wipes, creams, etc) that is safe for use on your baby’s stoma. Chemicals such as alcohol can be detrimental to your child if it is absorbed through the skin around the stoma.