Structural Defects

structural defects

esophageal atresia and tracheoesophageal fistula, cleft lip and/or palate, anorectal malformation, hypospadias

esophageal atresia/tracheoesophageal fistula

atresia: disconnect of the esophagus and the stomach; pocket

fistula: hole in the esophagus leading to the lungs

esophageal and tracheoesophageal fistual treatment

NPO, low suction frequently, supine with head elevated at 30 degrees, surgery after being stable for 24 hours,

esophageal atresia and tracheoesophageal post op treatment

pain management, maintain NPO, don’t replace NG/OG tube if out of place, watch for signs of choking, slow advance in diet

esophageal atresia and tracheoesophageal complications

GERD, narrowing of pathways

esophageal atresia and tracheoesophageal educaiton

small frequent feeds, sit up while feeding, observe for adequate swallowing, feeding complicaitons, signs of regurgitation or choking 

cleft lip

opening in the top lip

cleft palate

opening in the roof of mouth

what causes a cleft lip or palate

low folate in the mom

cleft lip and palate diagnostic

apparent at birth, visual exam of oral cavity, sucking assessment

when does surgery for a cleft lip and palate have to happen

first surgery around 2-3 months old, required by 12 months old

cleft lip and palate post op surgery

do not put anything in their mouth, elbow immobilizers or tuck arms in, pain management, avoid suctioning, syringe feeding for 7-10 days, soft diet for children

cleft lip and palate feedings

sit upright, increase gas, able to breastfeed, burp frequently, special bottles, encourage to start feeding process early before going home 

cleft lip and palate risks

ototonitis media

anorectal malformations

rectal atresia, rectal stenosis, cloaca, imperforated anus

rectal atresia

pocket in the rectum, anus is present

rectal stenosis

good pathway but narrow

cloaca

complex issue, urine and poop excreted out the same hole, meconium stained urine

imperforated anus 

no anus, no stool 

anorectal malformation treatment 

NPO, IV fluids, imaging and surgery in the first 24 hours, colostomy or urostomy, monitor output and hydration, pain management 

anorectal malformation treatment goal

potty training around 2-3 years old, may be delayed

hypospadias

urethra is shorter than where it should be and somewhere along the shaft of the penis 

hypospadias treatment goals

peeing like everyone else and preserve as a sex organ

hypospadias surgery

around 8-10 months, deglove the penis, extend the urethra, stent is placed to keep the urethra stable, hold off on circumcision

hypospadias post op treatment

swollen and bruised, stent stays in for 5-10 days, no baths 

hypospadias pharm treatment

oxybutynin and prophylactic antibiotics

oxybutynin education

take for 8 days every 6-8 hours, treats the bladder spasms, discontinue when stent is removed 

what can the stent from the surgery for hypospadias cause

bladder spasms, arched back, stretched out legs

hypospadias care management

petroleum jelly on diaper and not on the tip of the penis