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  1. Newborn Surprises 1 Garth Asay, MD Chair, Division of Neonatal Medicine Mayo Clinic

  2. Surprise • A completely unexpected occurrence or appearance

  3. Newborn Surprises The Delivery Room

  4. I wasn’t really supposed to be on call that night..... I was simply covering for a few hours until my colleague returned from an out-of-town meeting.

  5. He said…. • “Don’t worry, I’ve got coverage for everything.” • “You will only get paged if there’s an unexpected problem with a newborn.”

  6. There was a full moon that night.

  7. A black cat crossed my path on my way to the hospital…

  8. As I walked in the door, I received an emergency page to come to the birthing room.

  9. Upon my arrival…

  10. I’ve got to think fast… This baby has... 1 = an abdominal wall defect 2 = an omphalocele 3 = a gastroschisis 4 = cloacal exstrophy 5 = Ganser syndrome

  11. I’ve got to think fast… This baby has... 1 = an abdominal wall defect 2 = an omphalocele 3 = a gastroschisis 4 = cloacal exstrophy 5 = Ganser syndrome

  12. GastroschisisHở thành bụng • 4 per 10,000 live births • Umbilical cord intact • Rarely associated with other anomalies • Surgical correction • Survival rate is > 90%

  13. The FIRST thing I must do is…. 1 = rush this baby to surgery 2 = pass an orogastric tube 3 = wrap the bowel with warm, sterile saline dressings 4 = start a peripheral IV

  14. The FIRST thing I must do is…. 1 = rush this baby to surgery 2 = pass an orogastric tube 3 = wrap the bowel with warm, sterile saline dressings 4 = start a peripheral IV

  15. I will also need to... 1 = monitor respirations 2 = wrap the bowel with warm, sterile saline dressings 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

  16. I will also need to... 1 = monitor respirations 2 = wrap the bowel with warm, sterile saline dressings 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

  17. Immediate surgical repair is possible…

  18. But the postoperative course may be difficult…

  19. Use of a silo for gastroschisis repair

  20. Gastroschisis vs Omphalocele • We know we have been dealing with gastroschisis, because an omphalocele has intestines covered within a sac. • An omphalocele looks more like...

  21. OmphaloceleThóat vị rốn

  22. Omphalocele • 2 per 10,000 live births • Umbilical cord extends from the sac • 50 – 75% association with other anomalies • Trisomy 13, 18, 21 • Survival rate variable • Depends on underlying conditions

  23. Treatment • Surgical repair • “Paint and wait”

  24. “Paint and Wait”

  25. “Paint and Wait”

  26. “Paint and Wait”

  27. “Paint and Wait”

  28. “Paint and Wait”

  29. BONUS Question!!!!! • A baby is born with • an omphalocele • macrosomia • a large tongue • What laboratory test should we be ordering at this point?

  30. Blood glucose level

  31. Beckwith-Weidemann

  32. On to more cases….

  33. Later that night, the nurse calls me about a newborn infant... • “....he coughed and spit up his first feeding ?” • “He has lots of secretions coming from his mouth?” • “I’ll be right over.”

  34. What should I be thinking? • Is there an obstruction?

  35. OK, lets get a chest and abdominal X-ray …and pass an orogastric tube first

  36. This baby has... 1 = necrotizing enterocolitis 2 = a double-bubble sign 3 = a tracheo-esophageal fistula with esophageal atresia 4 = jejunal atresia 5 = pneumothorax

  37. This baby has... 1 = necrotizing enterocolitis 2 = a double-bubble sign 3 = a tracheo-esophageal fistula with esophageal atresia 4 = jejunal atresia 5 = pneumothorax

  38. What to do next? 1 = do a careful exam looking for other anomalies 2 = Use continuous suction to the “pouch” 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

  39. What to do next? 1 = do a careful exam looking for other anomalies 2 = Use continuous suction to the “pouch” 3 = start a peripheral IV 4 = start antibiotics 5 = all of the above

  40. VACTERL Association • Vertebral anomalies (70%) • Anal atresia (80%) • Cardiac (50%) • TracheoEsophageal fistula (70%) • Renal anomaly (50%) • Limb dysplasia (65%)