A child born with intestinal atresia has an intestinal tract that does not run continuously as an open, single tube from top to bottom. Atresia means the intestine is either blocked or abnormally narrow in one or more places, including:
Neonatal intestinal obstructions can occur in the large intestine (colon), but they are less common. There are no known genetic syndromes or environmental factors linked to atresia, but patients with Down syndrome have a higher incidence of duodenal atresia than other children. Down syndrome babies with intestinal atresia also have a higher risk of cardiac defects.
Researchers believe congenital (before birth) intestinal atresia occurs as a random event during pregnancy when there isn’t enough blood supply to the baby’s intestine to allow proper development. The diminished blood supply cannot be detected when it happens, and there is nothing a pregnant mom or her physician can do to prevent it.
Sometimes, intestinal atresia is predicted by a prenatal ultrasound or magnetic resonance imaging (MRI) that shows polyhydramnios—an excess of amniotic fluid in a mother. Another marker is an intestine that is larger than it should be for the baby’s stage of development.
If, during your pregnancy, doctors suspect your child has intestinal atresia, you will have the support of a nationally-ranked team of nurses, physicians, surgeons and other specialists. We help you prepare for delivery and learn to care for your baby after he/she is treated.
Intestinal atresia is only confirmed after a baby is born and doctors do X-rays and an abdominal examination. If those results cause concern, doctors order more tests, such as a contrast-enhanced X-ray of the colon or stomach to evaluate where the blockage is.
As a result of the blockage during development, the first part of a baby’s small intestine (proximal) is enlarged and the lower part (distal) is smaller than normal. Newborns may show very little interest in feeding, or they may vomit soon after feeding. They do not have bowel movements and their bellies may be distended from gas.
Riley at IU Health has expert physicians and surgeons who are specially trained to repair intestinal anatomy and give children the ability to digest and eliminate food through the digestive tract. If your child has other conditions, we work closely with you as a unified, multidisciplinary team to coordinate every aspect of his/her health. Treatments vary, depending on the location of the blockage.
Most babies with intestinal atresia need surgery during the first 24 to 48 hours of life. Babies born with jejunal and/or ileal atresia receive an orogastric tube to drain the stomach before surgery. Surgeons make a small incision, locate the blockage, remove it and bring the end of the small intestine to the surface of the body, where feces goes into a bag on the outside of the body. When the intestine is brought to the surface to bypass the normal digestive tract, we call this a temporary stoma. If there is more than one blockage, a baby may have more than one temporary stoma.
Infants affected by duodenal atresia (the first and shortest section of the intestine) have a different treatment plan. Soon after birth, they receive an orogastric drainage tube to drain the stomach before surgery. When they are two or three days old, surgeons bypass the blockage and join the intestine above and below the atresia. This approach protects the blood supply and the pancreas located near the duodenum. The orogastric draining tube stays in place until the stomach recovers its ability to pump food.
Babies who receive temporary stomas during corrective surgery usually have them for six to eight weeks while inflammation in the abdomen subsides and the bowel recovers. Afterwards, another surgery reconnects the stoma to the bowel. A child may be in the hospital for a few weeks or a few months, depending on the severity of his/her condition and the length of recovery.
Most patients can begin feeding seven to 10 days after surgery. Meanwhile, they are nourished by intravenous nutrition (IV). Some newborns with intestinal atresia—especially babies with Down syndrome—have difficulty feeding by mouth. For this reason, surgeons may insert a feeding tube at the time of their corrective surgery. The tube goes across their abdominal wall and into their stomach. Most babies have their feeding tube removed before they go home from the hospital. If your baby needs a feeding tube longer, we will help you learn how to care for the tube and feed your child.
The shorter the length of bowel between the stomach and the stoma, the longer babies may need IV nutrition. A baby with a jejunal atresia, for example, has a short segment of bowel between the stomach and the stoma. They are less tolerant of food and more dependent on IV nutrition than children with ileal atresia, who have a longer segment of bowel for digestion.
Even after surgical intervention, some children have such a short intestine that they may remain on IV nutrition for weeks or years. In severe cases, a bowel transplant using small and large intestine from a donor may be necessary. Children who receive these transplants must be at least 12 months old and meet certain size requirements.
After surgery, physicians at Riley at IU Health will follow your child to make sure he/she is developing normally and receiving care for any other conditions. You also have access to skilled dieticians who can help you handle feeding concerns and make sure your child gets adequate nutrition. Parents of babies treated for intestinal atresia can expect to see their children lead normal lives as adults.
Physicians at Riley at IU Health and the Indiana University School of Medicine study prenatal MRI markers for intestinal atresia to see how they relate to outcomes after birth. Their goal is to improve prenatal diagnosis and treatment for intestinal atresia.
Visit the websites below to learn more about intestinal atresia.
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