tailieunhanh - Ebook Surgical care of major newborn malformations: Part 2

(BQ) Part 2 book “Surgical care of major newborn malformations” has contents: Esophageal atresia, esophageal atresia, malformations of the lung, congenital diaphragmatic hernia , extra hepatic biliary atresia, ovarian cysts, sacrococcygeal teratoma, vascular and lymphatic anomalies. | b1319 Surgical Care of Major Newborn Malformations CHAPTER 9 ESOPHAGEAL ATRESIA Frederick Alexander, .* Joseph M. Sanzari Children’s Hospital, Hackensack, New Jersey INTRODUCTION Esophageal atresia has remained the defining challenge for several generations of pediatric surgeons. Coveted by pediatric surgical fellows and featured in the commercial hit movie “M*A*S*H”, these cases have epitomized a pediatric surgeon’s ability to repair a catastrophic embryologic anomaly and restore normal life. Today, thanks to the contributions of many brilliant pediatric surgeons, anesthesiologists, and neonatologists, children with esophageal atresia cannot only survive but thrive as they head into early childhood. As a result of this work, associated anomalies have now surpassed esophageal atresia as the greatest barrier to survival and a rich quality of life. Nearly one third of all infants with esophageal atresia have associated anomalies connected with the VACTERL syndrome. Hence, once the diagnosis is made it is critically important to perform a complete physical examination and obtain an echocardiogram as well as appropriate radiologic imaging to rule out associated Vertebral, Anal or Intestinal, Cardiac, Renal, and Limb/Lung anomalies. Additionally, genetic and neurologic screening should be done in every case. Moreover, since many infants are now diagnosed prenatally, it is often important to consult with the maternal fetal medical specialist or fetal radiologist who may have pertinent information to share concerning associated anomalies. Historically, the incidence of esophageal atresia has been 1 in 5000 live births, although it does appear that, in developing countries, this rate may be declining *Address: Pediatric Surgical Associates, 30 West Century Road, Suite 235, Paramus, NJ 07652. E-mail: falexander@. 189 189 5/17/2012 3:05:14 PM b1319 Surgical Care of Major Newborn Malformations 190 F. Alexander as the result of selective