Congenital malformations of the digestive system represent organic diseases of the gastrointestinal tract in infants. Malformations of the gastrointestinal tract occur as a result of abnormalities in its formation during embryogenesis. They are the most common and require diagnosis in the first hours after birth. Delayed diagnosis can lead to complications and reduced treatment success. Neonatal care for children with gastrointestinal disorders should be appropriate, especially if the children have concomitant malformations of other organs. The purpose of our analysis was to review the literature on neonatal care for children with congenital gastrointestinal disorders.
Gastrointestinal defects in newborns are common. Their symptoms usually appear during the first 1-2 days of life and are associated with intestinal obstruction, manifested by vomiting, difficulty feeding, and abdominal distention. Some of the gastrointestinal defects can be diagnosed during prenatal care of the mother. Congenital malformations involving the gastrointestinal tract can be divided into upper and lower gastrointestinal tract abnormalities. Diseases of the foregut include the following pathologies: esophageal atresia with/without tracheal fistula, duodenal atresia pyloric stenosis, biliary atresia, and choledochal cysts. Midgut disorders include small intestine atresia, malrotation, and midgut volvulus, Meckel’s diverticulum, omphalocele, and gastroschisis. Hindgut disorders include Hirschsprung’s disease and anorectal malformation/imperforate anus [1, p. 1-17].
Despite the continuous progress in medicine and modern technologies used in surgery, there is still a considerable proportion of sick children with formed intestinal stomas. An ostomy in childhood is related to the treatment of congenital alterations, trauma, or some acute or chronic clinical situations. They have a definitive or temporary nature, depending on the underlying disease, as well as on other factors that may influence the reconstruction of the intestinal transit [2, p. 1].
M. Brenner and his co-authors tried to assess outcomes after repair of enterocutaneous fistulae (ECF) and identify factors that predict mortality and recurrence. The results of the study showed that the most common cause of mortality after ECF repair is unsuccessful surgery, which subsequently leads to recurrence. Risk factors for recurrence of ECF include inflammatory bowel disease, small bowel fistula, an interval of 36 weeks or more between diagnosis and surgery, and resection with anastomosis suturing [3, p. 500, 505].
Pat Black in his study described stoma care nursing management. He noted that successful rehabilitation of a stoma patient means continuing to provide proper care and preparing the patient for this new stage of life. Transitioning from hospital to home care is not easy, and many patients need visits from medical staff during home care [4, p. 350].
L. A. Voronovà highlighted the main focuses of care in the early postoperative period for children with stomas: protecting the stoma, controlling the blood supply to the stoma, and covering the fistula with a bandage made of hygroscopic material to prevent drying out. Further care includes regular examination of the stoma, protection from trauma, and protection of the skin in the stoma area from exposure to stoma secretions (use of a fecal colostomy bag) [5, p. 2].
The development of medical technologies has had a positive impact on infant mortality, giving children with physiological disorders and birth defects a better chance of survival and thus increasing the number of children dependent on medical care. The imposition of an ostomy in infancy affects the physical integrity of the body, as well as the dynamics of the infant's socialization. Medical personnel play a significant role in the recovery and rehabilitation of newborns with gastrointestinal disorders in the postoperative period. Correct and timely implementation of medical prescriptions and proper neonatal care for children create the conditions for their speedy recovery.
References:
1. Verma R. Congenital Anomalies of the Gastrointestinal Tract. 20 p. URL: 10.5772/intechopen.92588
2. Correia P., Melo M., Silva A. [et al.]. Sociodemographic and clinical characterization of children with stoma: an epidemiological study. ESTIMA, Brazilian Journal of Enterostomal Therapy. 2022. Vol. 20. URL: 10.30886/estima.v20.1171_IN
3. M. Brenner, L. Clayton, A. Tillou [et al.]. Risk factors for recurrence after repair of enterocutaneous fistula. Arch. Surg. 2009. Vol. 144 (6). P. 500-505.
4. Black P. Stoma care nursing management: cost implications in community care. Br. J. Community Nurs. 2009. Vol. 14 (8). P. 352–355.
5. Voronovà L. A. Features of care for newborns with congenital defects of the gastrointestinal tract. Nursing. 2019. Vol. 2. P. 31-33.
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