Newborn Anomalies of the Airway, Gastrointestinal Tract, and Genitourinary System

Newborn Anomalies: In close cooperation with the high‐risk perinatology patients, the pediatric surgeon becomes involved early on in the developmental stages of the fetus. We are introduced to expectant mothers who are carrying fetuses with known anatomic abnormalities. Early detection by improved ultrasound techniques and expertise has allowed parents to be counseled prior to the birth of their baby, thus reassuring them of the potential excellent clinical outcomes. Some examples of mothers who we meet during their pregnancy are:

Congenital Diaphragmatic Hernia: A condition in which there is a defect in the diaphragm separating the abdominal and thoracic cavities. The abdominal contents reside in the chest, inhibiting normal lung development on the affected side and potentially affecting the function of the remaining “good” lung. Antenatal consultation takes the parent through the delivery, type of mechanical ventilation, other possible support modalities such as ECMO (extracorporeal membrane oxygenation), and surgical repair. Parents are able to see preoperative and intraoperative photos of babies with CDH and are afforded the opportunity to ask questions. They are always referred to the neonatologists for an antenatal consult as well.

Lung Anomalies: Foregut duplications comprise a group of thoracic anomalies that represent abnormal development of the aerodigestive tract. These present on antenatal ultrasound as space‐occupying lesions in the chest. These lesions include lung anomalies such as CCAM (congenital cystic adenomatoid malformation), with is dysfunctional lung parenchyma with cysts. Pulmonary sequestrations are abnormal areas of lung tissue either within the lung or adjacent to the lung. These anomalies are usually supplies by the aorta rather than the pulmonary circulation. Congenital emphysema is a condition in which one segment, or lobe, of lungs inflates abnormally and compresses the adjacent normal lobes and sometimes the heart and the other “good” lung. Removal via open thoracotomy is warranted in each of these situations.

Intestinal anomalies: A variety of developmental abnormalities resulting in intestinal obstruction occur. These occur from the mouth to the anus. Common locations are the esophagus (esophageal atresia with or without fistula to the trachea), duodenal atresia (increases incidence in Trisomy 21). Atresias of the small intestine may be singular of multiple and present as intestinal obstruction. Unlike the pulmonary anomalies above, these lesions require operation usually in the first day or two of life. Obstruction can even occur at the anus in the case of imperforate anus. Early operation is required to alleviate the obstruction. These conditions are also noticed on antenatal ultrasound and present as intestinal dilation.

‐ Nicholas C. Saenz, M.D., Pediatric Surgery