Neonatal disorders mean disturbance of normal state of body, organs and abnormal function of a newborn.

This birth disorders could vary from

• GIT disorders
• respiratory tract disorders circulatory tract disorders

GIT DISORDER

CLEFT LIP PALATE

• This are congenital deformities which occur due to failure of the function of the tissue found in the lips and pallet.
• this are also congenital facial malformations resulting from the faulty embryonic development
• Cleft lips and pallet almost invariably affect the upper lips.
• It may occur alone on it owns
• It may affect both sides.
• It may affect one side of the face and nostrils.

CAUSES OF CLEFT LIP AND PALATE

• One of the major causes is Cortisone inhalation and intoxication
• Viral infection e.g Rubella
• Oxygen/vitamin deficiencies
• Ultraviolet radiation
• Mutant gene- this is as a result of high incidence in monozygotic twins which is most common in kale twins
• Terri genius agent e.g drugs that are very halidomite

SIGN AND SYMPTOMS

• Abnormal breathing pattern
• Difficult in feeding
• Sighs of dehydration
• Nasal cartarh
• Impaired speech
• Skin tug-or

MANAGEMENT OF COMMON CLEFT LIP AND PALATE

1. In cleft lip, treatment is carried out 3-4 months surgically
2. In preop care the child must be trained on how to take food with a special spoon
3. Swag got culture and sensitivity both nostril and throat

POST-OP CARE

• Do all Nursing care as required to other post op care.
• Fluid observation is strictly in cleft lip and palate.
• Check if site is bleeding of not before taking to the ward.
• Observe strictly 15-30-1hr.
• Observe for sign of pain, facial expressions and cry.
• Maintenance of personal hygiene with sterile gauze.
• Give antibiotics as prescribe e.g cefuroxine, ceftriaxone.
• Clean mouth with convenience. on discharge therefore refer child to special speech therapist.

2. OESOPHAGEAL ATRESIA

• This is a congenital disorder in which a baby’s esophagus does not form properly during pregnancy.
• With esophageal atresia, babies have two separate tubes instead of one—and they are not connected to each other.

• Esophageal atresia comes in several different forms, some of which can cause additional complications for your baby.
• Up to 90% of babies with esophageal atresia also have another birth defect called a tracheoesophageal fistula: This means their esophagus connects to their trachea — their windpipe — instead of their stomach.
• This can cause them to inhale or choke on what they swallow.

TYPES OF OESOPHAGEAL ATRESIA

The different types of esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), are defined by where the esophagus is closed and where it connects to the trachea, if it does.

1. Type A : While it isn’t the most common, Type A is the most classical version of esophageal atresia.

• This version doesn’t include a tracheoesophageal fistula.
• Instead, the esophagus is simply closed at the bottom.
• It ends some distance above the stomach as a closed pouch.

Type B : In Type B, the esophagus is closed at the bottom, and a tracheoesophageal fistula branches off from the upper part of the esophagus, connecting it to the trachea.

Type C : This is the most common type of esophageal atresia.

• In Type C, the esophagus is in two separate pieces. The upper part that connects to the mouth ends in a closed pouch.
• The lower part connects to the stomach at the bottom and the trachea at the top.

Type D: This is the rarest type, and also the most severe.

• In Type D, the esophagus is in two unconnected segments, and both segments have separate tracheoesophageal fistulas.

SIGN AND SYMPTOMS

• Coughing.
• Choking.
• Cyanosis (a bluish tint to the skin, a sign of low oxygen).
  Additional signs and symptoms can include:
• Foamy mucus in your baby’s mouth.
• Excess saliva, spitting up or drooling.
• Gagging when attempting to feed.
• Respiratory distress.

CAUSES

Esophageal atresia is a congenital malformation, which means something forms differently during fetal development, leaving a defect that’s present at birth.

• In typical fetal development, the esophagus and trachea begin as one tube, which later separates. Esophageal atresia (and often, tracheoesophageal fistula with it) occurs when this tube doesn’t finish developing and separating. This is the main cause.

MANAGEMENT

Treatment for esophageal atresia includes

• stabilizing baby’s breathing,
• providing safe nutrition and ultimately,
• repairing the malformation through surgery.
• Some babies may be in the hospital longer than others.

Most of the time, surgery can fix the abnormality soon after the baby is born.

• Some babies may need to stay a little longer in the hospital, receiving nutrition and breathing support, before they’re ready for the operation.
• They may need more time to grow if they were born prematurely or if their esophagus is too short to repair.
• Some may need treatment for other life-threatening conditions first, like heart malformations.

INITIAL MANAGEMENT

1. Suctioning of fluids from your baby’s esophagus.
2. Installing a breathing tube to protect their airway.
3. Installing a feeding tube or IV to deliver nutrition and fluids.
4. IV antibiotics to prevent or treat pneumonia.

EXTENDED NEONATAL CARE

• Some babies may need to spend more time in the neonatal intensive care unit (NICU) before they’re ready for esophageal atresia surgery.
• This includes babies born prematurely, babies with multiple congenital malformations and babies with long-gap esophageal atresia (LGEA).
• Long-gap EA means that the two segments of the esophagus are too far apart to connect in surgery.
• They need more time to grow and close the gap.

SURGICAL REPAIR

The goals of esophageal atresia surgery are to:

• Connect separate segments of the esophagus together (anastomosis).
• Close off any connections between your baby’s esophagus and airway.
• Depending on THE baby’s condition, surgery Can be done for all of this, or they surgery in stages, addressing the fistulas first.

Surgery on the baby’s esophagus is called thoracic surgery. which is an incision through the thoracic cavity.

• When possible, surgeons use minimally invasive surgery methods to repair esophageal atresia.
• This means the baby’s chest is access through small incisions instead of opening it up.
• A surgeon inserts a small video camera (thoracoscope) through one micro-incision and operates through another, guided by the video.

COMPLICATION

• Rarely, the repaired esophagus may continue to leak even after it’s had ample time to heal. This means the anastomosis failed for some reason. An anastomotic leak would require a second surgery to fix it.
• Another possible complication is that the esophagus develops excessive scar tissue at the site of the anastomosis, which makes it too narrow (esophageal stricture). It might need stretching after surgery.

3. EXOMPHALOS (OMPHALOCELE)

Exomphalos is a type of abdominal wall defect.

• It occurs when a child’s abdomen does not develop fully while in the womb.
• Early in all pregnancies, the intestine develops inside the umbilical cord and then usually moves inside the abdomen a few weeks later.
• In exomphalos, the intestines and sometimes other organs such as the liver, remain inside the umbilical cord but outside the abdomen.

CAUSES OF EXOMPHALOS

• The causes still remain IDIOPATHIC
• Although it is becoming more common, affecting around two in every 5,000 children born each year. Exomphalos can be associated with other problems.

GASTROSCHISIS

Gastroschisis is a birth defect in which an infant’s intestines stick out of the body through a defect on one side of the umbilical cord.

• The child’s intestines can be easily seen.
• The condition is similar to an omphalocele (EXOMPHALOS), a birth defect in which the infant’s intestine or other abdominal organs stick out of the belly button area.
• Other associated congenital defects are rare in patients with gastroschisis.

INCIDENCE

The reported incidence of abdominal wall defects in the United States is estimated to be the following:

1. Gastroschisis: 1 case in 2,229 births (about 1,871 infants each year)
2. Omphalocele: 1 case in 5,386 births (about 775 babies annually)
3. Bladder exstrophy: 1 case in 50,000 births
4. Ectopia cordis: 1 case in 125,000 births
5. Cloacal exstrophy: 1 case in 10,000 – 70,000 to 1 case in 200,000 – 400,000 births.

CLINICAL MANIFESTATIONS OF EXOMPHALOS

• Exomphalos is immediately recognisable because the child’s intestines are outside the body and covered in a membrane.
• The size of the bulging membrane containing the intestines and other organs varies from a small protrusion to quite a large lump.

TYPES
There are two types of exompahlos:

1. Exomphalos minor: This is where the opening is less than 4cm and only containing the intestine.
2. Exomphalos major: This is where the opening is greater than 4cm and/or with the liver inside the cord.

DIAGNOSIS

• In many cases, exomphalos is visible on prenatal ultrasound scanning, which is useful because it gives time for discussions and planning for when and where to give birth.
• Generally, children are born naturally (vaginal childbirth) but some, especially if they have a very large exomphalos, may need a caesarean section.

MANAGEMENT OF EXOMPHALOS

Exomphalos is a serious condition so needs prompt treatment soon after birth.

• Children born with exomphalos are usually transferred to a special facility immediately.
• Immediately after birth, if the membrane covering the intestines is intact, the child will be kept warm and hydrated until they are transferred to a special facility.
• Depending on the size of the exomphalos, the infant may need to have it repaired in one operation or in several stages.
• If the exomphalos is small and the child is stable, they may have an operation soon after transfer, where the surgeon replaces the contents back inside the abdomen and closes up the base of the umbilical cord.
• If the exomphalos is larger, contains the liver and/or the child needs to be stabilised, doctors may place a silo or pouch over the intestines, which is closed over a period of days to weeks, to allow the child to grow so that there is room inside the abdomen.
• Therefore the basical treatment of exomphalos is SURGERY.

GASTROSCHISIS

In gastroschisis, there appears to be a weakness in the body wall (caused by defective ingrowth of mesoderm, or impaired midline fusion, or inappropriate apoptosis) that allows the intestines to herniate through this defect into the amniotic cavity.

Omphaloceles and gastroschisis

1. Omphaloceles
In infants with omphaloceles, the intestines do not return to the abdominal cavity; rather, they remain within the extra-embryonic coelom (amniotic cavity) bounded by the umbilical ring.

• There is evidence to suggest that omphaloceles have a genetic etiology, as follows:

1. Omphaloceles are associated with increased maternal age.
2. Omphaloceles occur in twins, consecutive children, and different generations of the same family.
3. Omphaloceles are associated with trisomy 13, 18, and 21 (in 25%-50 % of cases) and with Beckwith-Wiedemann syndrome

2. Gastroschisis
In gastroschisis, there appears to be a weakness in the body wall (caused by defective ingrowth of mesoderm, or impaired midline fusion, or inappropriate apoptosis) that allows the intestines to herniate through this defect into the amniotic cavity..

• Gastroschisis occurs in young mothers with low gravida; it is associated with prematurity and small-for-gestational-age (SGA) infants, and denotes in utero growth retardation.
• The clustering of cases (number and severity) suggests a multifactorial etiology, including environmental factors acting upon susceptible hosts.

IMPERFORATE ANUS (ANAL ATRESIAIMPERFORATE ANUS (ANAL ATRESIA)

• This is the absence of anal opening
• It is obvious at birth
• Ensure a Rectal thermometer is inserted at birth to diagnose Imperforate Anus as a midwife
• Therefore it is a congenital anorectal malformation (ARM) where a normal anal opening is absent at birth.

CAUSES

Imperforate anus may occur in several forms:

1. The rectum may end in a pouch that does not connect with the colon.
2. The rectum may have openings to other structures. These may include the urethra, bladder, base of the penis or scrotum in boys, or vagina in girls.
3. There may be narrowing (stenosis) of the anus or no anus.

Therefore, it is caused by abnormal development of the fetus.

• Many forms of imperforate anus occur with other birth defects.