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The Paediatric General Surgery team is currently led by 4 Consultant Paediatric Surgeons. Each of the 4 Consultants work closely with the neonatologists providing care for the babies on NICU and SCBU. In addition, each of the consultants leads a specific area within the field of practice. This may mean that your child's care commences under the care of one Consultant but is then transferred to another depending on your child's diagnosis.

 

Each Consultant has a Specialist Registrar linked to them and, to allow the Registrars to maximise their experiences within the department, they will rotate every 6 months to a different Consultant within the team. At least one of the Registrars visits NICU/SCBU daily to review the babies under joint care with the Paediatric General Surgery team. Within the team there are also two Clinical Nurse Specialists who are available to provide teaching, advice and support to parents.

 

 

 

Necrotizing enterocolitis (NEC)

 

Necrotising enterocolitis (NEC) is a disease of the intestine (bowel); which causes infection and inflammation of the bowel tissues. If the disease progresses it can lead to part or whole of the bowel dying.

 

Treatment for necrotising enterocolitis is usually by resting the gut and giving intravenous antibiotics.  However it may be necessary to operate to remove a portion of the bowel. The remaining ends of the bowel are either joined back together or brought up to the skin to form a stoma (see below). More information about the diagnosis and treatment of NEC can be found in the FAQ sheet below.

 

NEC affects approximately 5% of all babies admitted to the NICU. In premature and low birth weight the occurrence of NEC is between 10% and 20%.

 

 

Stoma Care punctuation

 

This enables waste materials from the gut to pass through the stoma and empty into a bag known as a colostomy bag.

More information about stomas and stoma care can be found in the FAQ sheet below.

 

 

Other surgical conditions

 

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Diaphragmatic hernia

 

Diaphragmatic hernia occurs early in development when the diaphragm which separates the lungs and the abdominal contents fails to form properly.

 

The problem is usually diagnosed antenatally. Babies who have a diaphragmatic hernia will have some contents of the abdomen in place of where the lungs should be, affecting the development of the lungs. As the lungs are not used while the baby is in the womb this does not cause any problems. However when the baby is born he will have difficulty breathing. The amount of lung which has been squashed will determine how unwell the baby is when he is born. In all cases the neonatal team will be present at the delivery and will intubate and ventilate the baby before transferring the baby to the neonatal unit. Although the final treatment is surgical repair of the hole in the diaphragm, this can only be done when the baby is stable enough. Sometimes the baby requires a lot of ventilatory support including high frequency oscillatory ventilation and nitric oxide (see jargon buster). After the surgery the long term outcome depends upon the amount of healthy developed lung remaining. Babies often need additional support for their breathing and help establishing feeds several weeks after the operation.

 

As with all babies with surgical conditions, they are followed up by the neonatal surgical team.

 

 

Exomphalos

 

Exomphalos occurs when the gut fails to return into the abdominal cavity during development. It is usually picked up on antenatal scans, and requires surgical treatment. The herniated gut is retained in a sac usually similar to the umbilical cord. Surgery will be planned for your baby as soon as possible after delivery, and feeding can be commenced following repair.

 

 

Gastroschisis

 

Gastroschisis is a condition where the abdominal contents are outside due to a defect in the abdominal wall. It is usually picked up on antenatal scans. It is different from exomphalos (above) in that the gut is not covered in a membrane. This means that surgical repair has to occur soon after the baby is born. Either all of the gut is put back into the abdomen in one go or the gut is put into a bag, known as a silo, and gradually pushed back in over a few days.

Feeding can be commenced slowly once the gut is back in the abdomen and the baby is stable.

 

 

 

Hirschsprung's Disease

 

Hirschsprung's Disease is a congenital condition which can cause extreme constipation, pain, and intestinal blockage. Anemia, bloody stools and diarrhea may also be noted with the condition. Hirschsprung's Disease manifests as a lack of appropriate nerve cells in the large intestine or colon. When the body cannot sense that the colon is full with waste products, the intestine can back up. In infants this may be seen as infrequency of bowel movements, which may be accompanied by painful spasms. Because of larger bowel movements, the sensitive skin around the anus can tear, causing blood in the stool.

The normal treatment for an infant with Hirschsprung's Disease is called a pull through surgery. The non-functioning part of the intestine is removed and the areas of the intestine with normal cells are rejoined. This results in a healthy intestinal tract and has a high rate of success. Surgery can treat the causes and most children with Hirschsprung's Disease lead normal lives after surgery.

 

Occasionally, children have developed significant infection in their large intestine prior to the pull through surgery and must undergo an ostomy. In this procedure, the infected portion of the intestine is first removed, and fecal matter collects in a bag outside the body. This procedure is usually temporary, and when the child regains health and strength, he or she will undergo the pull through.

More information about stomas and stoma care can be found in the FAQ sheet below.

 

 

 

 

 

Inguinal Hernia

 

The inguinal canal is a tube that passes through a natural hole in the muscles of the groin. In babies, especially those born prematurely, occasionally part of the gut can get stuck in the tube. This can result in a swelling/bulge in the groin. The hernia may be on one or both sides.

 

If your baby has an inguinal hernia he/she will need to have an operation at some stage as there is a risk that a piece of bowel can become trapped in the inguinal canal (this is called a 'strangulated hernia'). This will cause him/her to become unwell with pain and can cause damage to the bowel if not treated promptly.

 

 

Malrotation

 

When the gut develops it has to fold up in the abdomen in a certain way. If it folds up the wrong way this is known as malrotation and can cause obstruction of the bowel (volvulus). Sometimes an obstruction can be seen antenatally. If this is suspected then when your baby is born he/she will be admitted to the neonatal unit and an x-ray of the abdomen taken. Your baby will be on a drip and will not be fed until this is done. If the diagnosis is correct your baby will require an operation to untwist the bowel and release the obstruction. If there is no sign of obstruction on the x-ray we will allow your baby to feed while closely observing him/her.

 

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Tracheo-oesophageal fistula (TOF)and oesophageal atresia (OA)

 

These are both rare conditions which occur early in the baby’s development. They can occur individually or together and can sometimes be suspected on the antenatal ultrasound scan.

 

TOF occurs when the trachea (windpipe) and the oesophagus (the food pipe) remain attached. Without surgical intervention this causes air to pass from the wind pipe to the food pipe and stomach. It can also allow stomach acid to pass into the lungs. Babies with OA are born with a small pouch at the top of the oesophagus which prevents food from reaching the stomach. Consequently, these babies cannot swallow their own saliva and require continual suction to remove secretions from the pouch.

 

Both conditions require surgical repair, the timing and nature of which depend on the specific problem.

 

 

 

 

 

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