Participating in the seminar's first session were Dr. William R. Richardson, Kings County Hospital, Brooklyn, New York, who served as moderator, Dr. Thomas Santulli, Children's Surgeon at Columbia-Presbyterian Hospital, New York City, Dr. Marel H. Harmel, Anesthesiologist at Kings County Hospital, and Dr. Lawrence K. Pickett, Chief of Surgery at the State University of New York Medical Center in Syracuse. All speakers emphasized the importance of closely co-operative effort by pediatricians, surgeons, radiologists, anesthesiologists and nursing personnel to facilitate early recognition, diagnosis and effective treatment of neonatal complications requiring surgery.
Early recognition of surgical problems usually depends upon the observations of well-trained nurses. Any history of obstetric complications especially breech presentation, a maternal history of hydramnios, any signs of respiratory distress, difficulty in swallowing at the time of the first feeding, emesis of bile-stained fluid, abdominal distention, or failure of the appearance of the first stool within 24 hours after birth should alert all observers to the possibility of complications which will require surgery.
As soon as respiratory or gastrointestinal complications are suspected, Dr. Pickett requests radiologic consultation. A roentgenogram of the chest, taken at this time, will delineate not only the infant's pulmonary status, but also the gas pattern of the intestinal tract. When the clinical picture suggests gastrointestinal obstruction, Dr. Pickett and his colleagues employ a No. 8 to 10 French soft rubber catheter, specially prepared by punching several holes in its terminal 1 cm portion. This tube is inserted under fluoroscopic control and passed cautiously to avoid traumatic puncture of any obstructing tissue which may be encountered When esophageal atresia is recognized the proximal esophageal pouch is carefully aspirated to remove pooled saliva.
- Copyright © 1957 by the American Academy of Pediatrics