What should be checked at birth in a case of jejunal atresia?

Comprehensive Assessment Protocol for Jejunal Atresia at Birth

At birth, neonates with jejunal atresia require immediate comprehensive evaluation of multiple systems to assess for associated anomalies, establish diagnosis, and prepare for surgical intervention.

Initial Clinical Assessment

• Bilious vomiting: Assess for presence and timing - typically begins within first 2 days after birth and is usually bilious 1
• Abdominal distension: Evaluate for proximal bowel obstruction 1
• Meconium passage: Document absence or delayed passage, which is typical for distal bowel obstruction 1
• Vital signs: Monitor for signs of dehydration or electrolyte imbalances

Diagnostic Imaging

• Abdominal radiographs: First-line imaging to identify obstruction pattern 1

  • Look for "triple bubble" sign with no gas distally, which indicates jejunal atresia 1
  • Assess for multiple distended bowel loops suggesting distal obstruction

• Contrast enema: Indicated when radiographs show distal bowel obstruction 1, 2

  • Can identify microcolon in congenital atresia
  • Differentiates between structural and functional causes of obstruction

• Upper GI series: Generally not necessary with classic radiographic findings 1

  • May be considered if diagnosis remains unclear

Laboratory Evaluation

• Complete blood count: Assess for infection or anemia
• Electrolytes: Monitor for imbalances, particularly sodium, potassium, and chloride
• Renal function tests: Evaluate for pre-renal azotemia from dehydration
• Blood glucose: Monitor at least daily while on parenteral nutrition 1

Associated Anomaly Screening

• Cardiovascular assessment: Echocardiogram to rule out associated cardiac defects
• Genetic evaluation: Consider karyotyping, especially with multiple anomalies
• Renal ultrasound: To identify associated renal anomalies
• Fluid balance monitoring: Document bilious vomiting, abdominal distention that may indicate pyloric atresia 1

Preoperative Preparation

• Intravenous access: Secure reliable IV access by experienced practitioner 1

  • Use low-adherent tape and preventative padding under tourniquets

• Fluid resuscitation: Correct dehydration and electrolyte abnormalities 1

  • Parenteral nutrition should not be started until patient is hemodynamically stable 1

• Nasogastric decompression: Place tube with water-based lubricant and secure with low-adhesive tape 1

Surgical Planning Considerations

• Multiple atresias: Be aware that atresias can be multiple in approximately 15% of patients 1
• Complex variants: Assess for associated conditions such as:
  • Apple peel deformity 3
  • Absent mesentery 3
  • Distal volvulus 4
  • Multiple atresias 4

Post-Birth Monitoring

• Short bowel risk assessment: Evaluate risk factors for short bowel syndrome, present in complex cases 4
• Parenteral nutrition planning: Many patients require parenteral nutrition for 7-10 days post-surgery 1
• Electrolyte monitoring: Special attention to sodium, potassium, and magnesium balance 1

Pitfalls and Caveats

• Don't delay diagnosis: Bilious vomiting in the first days of life is an ominous sign requiring urgent evaluation 1
• Consider multiple atresias: Complex jejunal atresia may involve multiple sites of obstruction 4
• Avoid unnecessary tests: Precautionary blood tests are not recommended; only monitor if clinically indicated 1
• Recognize complex variants: Complex jejunal atresia can cause critical problems after correction and requires aggressive multidisciplinary approach 4
• Distinguish from ileal atresia: Jejunal atresia has more prolonged postoperative course and higher mortality compared to ileal atresia 5

Early diagnosis and proper management are critical for improving outcomes in neonates with jejunal atresia, with particular attention to associated anomalies and complex variants that may significantly impact prognosis.