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Antenatal information for bowel atresia

From your antenatal scans there are indications your baby may have a bowel atresia. This information is to help you understand the condition and what will usually happen to your baby if they are diagnosed with a bowel atresia (intestinal atresia), and are transferred to the Neonatal Surgical Unit (NSU) at the Sheffield Children’s NHS Foundation Trust Hospital for treatment and care.

What is a bowel atresia?

This is when the bowel (intestine) has not developed properly resulting in a blockage (obstruction) in part of the bowel. This blockage can be due to a gap in the bowel known as atresia or a narrowing known as stenosis. Due to the blockage the fluid and feed is unable to pass through from the stomach in to the bowel.

It occurs in 1 in 5000 babies. More commonly it occurs in the small bowel in the jejunum (jejunal atresia) or ileum (ileal atresia). It rarely occurs in the large bowel (colonic atresia).

Illustration of healthy intestine, stomach and bowelIllustration of intestine with atresia meaning part of the intestine is pinched and is blocked up

How is this diagnosed?

Your antenatal scans have indicated your baby may have a bowel atresia due to some observations about you and your baby. This includes polyhydramnios (more amniotic fluid than normal) and, dilatation (distension) of the bowel noted on your ultrasound scans.

Further tests including a MRI may be organised by your obstetrician to obtain more information. Bowel atresia cannot be definitively diagnosed until after your baby is born.

When, how and where will my baby be born?

The aim will be for your baby to be born at the Jessop Wing, Royal Hallamshire Hospital in Sheffield. Babies with bowel atresia tend to be born before they are due. Your obstetrician will closely monitor your baby, and they will recommend when and how your baby will be born. They will discuss this with you.

What will happen when my baby is born and the diagnosis of bowel atresia has been made?

When your baby is born they will be seen by the neonatologists (baby doctors) and taken to the Neonatal Intensive Care Unit (NICU) at the Jessops Wing to be assessed and observed.

Your baby will have an X-ray of their abdomen, and possibly other tests to confirm they have a bowel obstruction. The surgeons may come to see and assess your baby on NICU if they are not transferred to the Neonatal Surgical Unit shortly after being born.

Your baby will be connected to a monitor for recording their heart rate, breathing rate, oxygen level and blood pressure. A plastic tube, often called a ‘drip’ (intravenous cannula) will be inserted in to your baby’s vein to give intravenous fluids, antibiotics and other medicines your baby may need. Your baby will not be able to feed initially. The nurses will pass a tube called a gastric tube in through your baby’s nose in to their stomach. This is to drain the contents of the stomach to keep your baby comfortable and to stop them being sick.

The surgeons will liaise with the neonatologists at the Jessops Wing and may see your baby there.

When will my baby go to the Neonatal Surgical Unit?

When your baby is stable and there is a bed for your baby on the Neonatal Surgical Unit (NSU) they will be transferred there by Embrace. Embrace are a specialist transport team who are experienced in transferring babies, including those who have bowel atresia and bowel obstructions.

Sometimes your baby may need to stay on NICU for a longer period of time before being transferred to the NSU. In this situation the surgeons will come to NICU to review and be involved in your baby’s treatment there.

How will my baby’s small bowel atresia be treated?

Your baby will need an operation. This may be done as keyhole surgery (laparoscopically) or as open surgery.

The surgeon will examine the bowel to identify the blockage. The surgeon will need to remove the atresia or stenosis and join the ends of the bowel together to enable feed and fluid to pass through the bowel. Occasionally there may be more than one atresia seen. Sometimes in certain situations the surgeon may not join the ends together. They will bring the end of the bowel to an artificial opening (stoma) in the abdomen (tummy) to form an ileostomy or a jejunostomy.

The baby will need another operation at a later date to close the stoma and join the ends of the bowel. The surgeons will explain the operation to you at the time and you will need to give consent. You will also be seen by an anaesthetist because your baby will need a general anaesthetic for the operation.

What happens after the operation?

Your baby will be given pain relief and will continue to be monitored closely. They will still have the gastric tube in after the operation. The colour and amount of fluid that drains from this tube will be closely monitored, and will give us information about:

  • how your baby is recovering from the operation
  • when their bowel is starting to function (work)
  • when they can start having milk feeds

When your baby can have milk feeds it will be introduced very slowly in small amounts and increased as tolerated.

Most babies who have small bowel atresia will need to have intravenous feeding whilst they are waiting to have their having milk feeds introduced and until they can tolerate the full amount of milk they need. The intravenous feed is called parenteral nutrition (PN) which provides all the nutrients your baby needs to grow which they would normally get from milk. PN is given via a special ‘drip’ in their veins. This will be explained to you at the time.

What milk can my baby have?

Breast milk is very important for every baby but especially if your baby is poorly. If you wish to breast feed or give your baby your breast milk we will support and help you in expressing your breast milk and establishing breast feeding. Your midwife can help you to start expressing after your baby has been born.

We have facilities on NSU for expressing and there are infant feeding specialists in the hospital who can advise and support you with this as well as the NSU nurses. Your breast milk can be frozen until your baby is ready to have it. You can also use your colostrum and breast milk for your baby’s mouth care.

If you do not wish to express your breast milk or are unable to do so, your baby can have formula milk of your choice. Occasionally the surgeons may wish your baby to have a special prescription milk formula. This will be discussed with you at the time.

Will my baby have other problems?

Babies with bowel atresia do not usually have associated problems. After your baby is born, they will be closely examined by the doctors, have X-rays and ultrasound scans and other investigations as necessary to check if they do have any other problems. This will be explained to you at the time.

Occasionally the length of the bowel may be reduced. In these circumstances the baby’s recovery will take longer and be more complicated. This will all be explained and discussed with you at the time.

How long will my baby be in hospital?

We are unable to predict how long your baby will be in hospital. Some babies with bowel atresia are only in for a few weeks, others can be in for longer. Your baby’s progress will be closely monitored by the surgeons, nurses and the other teams involved with your baby’s care. You will be updated regularly on your baby’s progress and will be able to ask and have questions answered throughout your stay on NSU.

When your baby is tolerating milk feeds and gaining weight they can go home. Your baby will be followed up by a paediatric surgeon in our outpatient clinics here at the Sheffield Children’s Hospital or at your local hospital. Your baby may also have regular follow up with other teams who may have been involved with your baby’s care.

What is the long term outlook for my baby?

Information:

The majority of babies with small bowel atresia do not have long term complications from this condition. They grow up to lead normal lives.

If they have additional problems they may require ongoing medical care and monitoring dependent on their problems. This will all be discussed with you as necessary.

Contacts and support

Are there support groups?

Neonatal Surgical Unit
Telephone: 0114 2717324 or 0114 2717705

BLISS

Group which offers general support to families of babies born early or sick

68 South Lambeth Road
London, SW8 1RL
www.bliss.org.uk
Facebook group: BLISS

Contact A Family

209-211 City Road
London
EC1 1JN
0808 808 3555
www.cafamily.org

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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S10 2TH

United Kingdom

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