NEWBORN WITH SURGICAL EMERGENCIES

Babies may be born at lower health facilities with congenital defects that require emergency surgical intervention at
tertiary levels:

  • The common surgical emergencies in neonates include: gastroschisis (defect of abdominal wall with intestine
    sticking outside the body), tracheoesophageal fistula, imperforate anus, and spina bifida
  • If diagnosed in lower level health facilities (HCII, HCIII, HCIV, District Hospital), apply general principles of
    supportive management of the newborn
  • The aim should be to avoid hypothermia, minimise risk of infection, ensure adequate hydration, and minimise risk of aspiration and hypoglycaemia

MANAGEMENT

  • Use sterile or clean gauze if available to properly cover the defects which are externally visible.
    For gastroschisis, moisten the gauze using warm saline and use it to properly wrap the exposed
    intestines
  • Properly cover the newborn using a clean thick linen to avoid hypothermia
  • Insert IV cannula gauge 24 and administer prophylactic antibiotics preferably IV antibiotics
    (ampicillin + gentamicin)
  • Keep the baby well hydrated (see IV fluids in neonates section 1.1.4)
  • If vomiting or signs of intestinal obstruction, pass a neonatal feeding tube Fr. G 6 or Fr. G. 8 (if
    available) and aspirate all the stomach contents
  • If tracheoesophageal fistula is suspected, insert the tube as above and ensure that the baby is kept
    in a propped-up position
  • Urgently refer the neonate to the nearest regional or national referral hospital for further advanced
    treatment and care