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Saint Louis University

School of Nursing




Tracheoesophageal Atresia Esophageal atresia is obstruction of Emergency surgery
and Fistula the esophagus. Often a fistula for the infant with
(opening) occurs between the tracheoesophageal
closed esophagus and the trachea. fistula is essential to
The five usual types of esophageal prevent the
atresia that occur are: development of
1. The esophagus ends in a pneumonia from
blind pouch; there is a leakage of stomach
tracheoesophageal fistula secretions into the
between the distal part of lungs or dehydration
the esophagus and the or an electrolyte
trachea imbalance from lack
of oral intake.
Antibiotics may be
prescribed to help
prevent infection.
A gastrostomy may be
performed (under
2. The esophagus ends in a local anesthesia) and
blind pouch; there is no the tube allowed to
connection to the trachea drain by gravity to
keep the stomach
empty of secretions
and prevent reflux
into the lungs.
Surgery consists of
closing the fistula and
3. A fistula is present between anastomosing the
an otherwise normal esophageal segments.
esophagus and trachea. It may be necessary
to complete the
surgery in different
stages and to use a
portion of the colon
to complete the
anastomosis if the
esophageal segments

 are far apart from
each other.
4. The esophagus ends in a
blind pouch. A fistula Observe infants
connects the blind pouch of closely at post-
the proximal esophagus to operative days 7 to
the trachea 10, when sutures
dissolve, because
leaks occurring at
anastomosis sites can
occur at this time.

5. There is a blind end portion
of the esophagus. Fistulas
are present between both
widely spaced segments of
the esophagus and the

Pyloric Stenosis The pyloric sphincter is the Treatment is surgical

opening between the lower or laparoscopic
portion of the stomach and the correction (a
beginning portion of the intestine, pyloromyotomy),
the duodenum. If hypertrophy or performed before
hyperplasia of the muscle electrolyte imbalance
surrounding the sphincter occurs, from the vomiting or
it is difficult for the stomach to hypoglycemia from
empty, a condition called pyloric the lack of food
stenosis . With this condition, at 4 occurs. 

to 6 weeks of age, infants begin to
vomit almost immediately after Before surgery, if
each feeding. The vomiting grows electrolyte
increasingly forceful until it is imbalance,
projectile, possibly projecting as dehydration, and
much as 3 to 4 feet. The incidence starvation have
is high, approximately 1:150 in already occurred,
males and 1:750 in females. It these must be
tends to occur most frequently in corrected by
first-born white male infants. The administration of IV
exact cause is unknown, but fluid, usually
isotonic saline or
5% glucose in

Oral feedings are

withheld to prevent
further electrolyte
multifactorial inheritance is the
likely cause. depletion. 

An infant who is
receiving only IV
fluid generally needs
a pacifier to meet
nonnutritive sucking

For surgical
correction, the
muscle of the pylorus
is split down to the
mucosa, allowing for
a larger lumen.
Although the
procedure sounds
simple, it is
technically difficult to
per- form, and there
is a high risk for
infection afterward
because the
abdominal incision is
near the diaper area.
Intussusception The invagination of one portion of The condition is a
the intestine into another usually surgical emergency.
Reduction of the
occurs in the second half of the intussusception must
first year of life. be done promptly by
In infants younger than 1 year, either instillation of a
intussusception generally occurs water-soluble
for idiopathic reasons. In infants solution, barium
older than 1 year, a “lead point” on enema, or air
the intestine likely cues the (pneumatic
invagination. Such a point might be insufflation) into the
a Meckel’s diverticulum, a polyp, bowel or surgery to
hypertrophy of Peyer’s patches reduce the
(lymphatic tissue of the bowel that invagination before
increases in size with viral necrosis of the
diseases), or bowel tumors. The effected portion of
point of the invagination is the bowel occurs.
generally at the juncture of the If there is no lead
distal ileum and proximal colon. point, just the
pressure of these
techniques may
reduce the
After this type of
reduction, children
are observed for 24
hours be- cause some
children will have a
recurrence of the
within this time. If
this occurs, children
will be scheduled for
an additional
reduction or surgery.
Hirschsprung’s Disease Hirschsprung’s disease, or Repair of aganglionic
(Aganglionic Megacolon) aganglionic megacolon, is absence megacolon involves
of ganglionic innervation to the dissection and re-
muscle of a section of the bowel in moval of the affected
most instances, the lower portion section, with
of the sigmoid colon just above the anastomosis of the
anus. The absence of nerve cells intestine (termed a
means there are no peristaltic pull-through
waves in this section to move fecal operation).
material through the segment of
intestine. This results in chronic Because this is a
constipation or ribbonlike stools technically difficult
(stools passing through such a operation to perform
small, narrow segment look like in a small abdomen,
ribbons). The portion of the bowel the condition is
proximal to the obstruction dilates, generally treated in
distending the abdomen. the newborn by two-
stage surgery: first a
temporary colostomy
is established,
followed by bowel
repair at 12 to 18
month of age.

The incidence of aganglionic

disease is higher in the sib- lings of
a child with the disorder than in
other children. It also occurs more
often in males than in females. It is
caused by an abnormal gene on
chromosome 10. The incidence is
approximately 1 in 5000 live births.

Tracheoesophageal Fistula Tracheoesophageal fistula is an Emergency surgery

abnormal connection in one or for the infant with
more places between the tracheoesophageal
esophagus (the tube that leads fistula is essential to
from the throat to the stomach) prevent the
and the trachea (the tube that development of
leads from the throat to the pneumonia from
windpipe and lungs). leakage of stomach
secretions into the
lungs or dehydration
or an electrolyte
imbalance from lack
of oral intake.
Surgery consists of
closing the fistula and
anastomosing the
esophageal segments.
It may be necessary
to complete the
surgery in different
stages and to use a
portion of the colon
to complete the
anastomosis if the
esophageal segments
are far apart from
each other.
Esophageal Atresia TE fistula often occurs with Antibiotics may be
another birth defect known as prescribed to help
esophageal atresia. The esophagus prevent infection.
is a tube that leads from the throat A gastrostomy may be
to the stomach. With esophageal performed (under
atresia, the esophagus does not local anesthesia) and
form properly while the fetus is the tube allowed to
developing before birth, resulting drain by gravity to
in two segments; one part that keep the stomach
connects to the throat, and the empty of secretions
other part that connects to the and prevent reflux
stomach. However, the two into the lungs.
segments do not connect to each

Medscape. (2018, September 19). Tracheoesophageal Fistula: Background, Pathophysiology,
Etiology. Retrieved September 30, 2018, from

Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & child health nursing: Care of the childbearing
& childrearing family (Vol. 6). Philadelphia: Wolters Kluwer.
Stanford. (2018). Default - Stanford Children's Health. Retrieved September 30, 2018, from