Intestinal Atresia

Doctors sometimes describe IA by naming the part of the bowel it affects. IA can be in:

• The first part of the small bowel, called the duodenum (pronounced doo-ODD-en-um)
• The middle part of the small bowel, called the jejunum (pronounced jeh-JOON-um)
• The last part of the small bowel, called the ileum (pronounced ILL-ee-um)
• The large bowel, called the colon

IA in the duodenum (duodenal atresia) is due to a problem with how the first part of the small bowel forms before birth. Babies with this condition may have other health problems at birth, such as Down syndrome and heart problems. This type is most often diagnosed during pregnancy.

IA in other parts of the bowel is most often caused by poor blood supply to that area before birth.

• Sometimes care starts before birth if an ultrasound during pregnancy shows your baby has IA. The team at our Fetal Care and Treatment Center can work with you to get ready for your baby’s birth and the treatment they will need early in life.
• We coordinate carefully with your birth hospital so your baby gets special care when they are born and as they travel by ambulance to Seattle Children’s.
• Our transport team of physicians, nurses and respiratory therapists are national leaders in safely moving fragile newborns.

• Each year, we care for 20 to 30 babies with IA. Your healthcare team will include specialists in newborn care (neonatologists), pediatric surgery, nutrition, the digestive system (gastroenterologists) and lactation support.
• Our surgery team is experienced in performing the procedures to repair your baby’s bowel. We are skilled at treating other bowel problems that sometimes affect babies with IA, such as gastroschisis.
• Seattle Children’s has the state’s first Level IV Neonatal Intensive Care Unit (NICU), the highest level of care. We are skilled and equipped to care for the sickest newborns.

• Your newborn needs care designed just for them. Babies differ from adults in how they react to illness, pain, medicine and surgery. That is why our surgeons are all board certified in pediatric surgery.
• We do only the tests, radiation and surgery that your child needs. We use lower radiation doses than recommended by the American College of Radiology.
• Seattle Children’s is 1 of just 5 hospitals in the nation recognized by ChildKind International for how well we prevent and treat pain in children.

• At Seattle Children’s, you have a full team behind you before, during and after surgery. We work together to meet all your child’s health needs.
• Having a baby born with IA can be scary. We take time to explain your child’s condition and help you fully understand your treatment options.
• Our doctors, nurses, child life specialists and social workers help your family through the challenges of IA. We connect you to community resources and support groups.
• We work with many children and families from around the Northwest and beyond. We can help with financial counseling, schooling for kids in the family, housing, transportation, interpreter services and spiritual care. Learn about our services for patients and families.

Seattle Children’s leads research in the lab and in the clinic to improve treatment and quality of life for children born with IA.

• Our Intestinal Rehabilitation Program does research on the most severe types of IA to help prevent problems like short bowel syndrome.
• Our newborn specialists are leaders in research to improve outcomes for babies born with complex problems. See Pushing Limits, Saving Lives.
• We work to find the safest, most effective ways to reduce stress in the NICU and to ease pain. Learn more about Seattle Children’s neonatology research.
• Our patients have the option to take part in research studies of promising new treatments. These are called clinical trials.

An ultrasound during pregnancy may show that your baby has intestinal atresia. One sign of IA is extra amniotic fluid inside the mother’s womb. This is called polyhydramnios (pronounced pahl-ee-hi-DRAM-nee-us). It happens because the baby’s bowel does not absorb normal amounts of amniotic fluid. 

Within 1 to 2 days after birth, babies with IA may have 1 or more of these symptoms:

• No stool passed (bowel movement)
• Swollen belly from gas
• Vomit that may be yellow or greenish in color
• Not wanting to eat

At the time of surgery, we will give your child medicine (general anesthesia) to make them sleep without pain. The doctors at Seattle Children’s who give your child anesthesia are board certified, with extra years of training in how to give pain medicine to children safely.

After making the cut in your child’s belly, the surgeon:

• Checks the bowel to find the parts that are blocked.
• Cuts on both sides of the blocked sections to make openings. This allows the bowel to become an open tube.
• Connects the parts of the bowel with stitches.
• Sometimes has to remove parts of the bowel to correct the problem.
• Sews closed the opening in the belly wall.

How long the surgery takes depends on how much of the bowel is affected.

After surgery, the team in our Level IV Neonatal Intensive Care Unit (NICU) will care for your baby.

We will give your child:

• Pain medicine for comfort
• Fluids and antibiotics through an IV tube in their vein

When your baby is ready, they move to a regular hospital room.

Sometimes it takes several weeks or longer for your child’s bowel to heal enough so they can eat by mouth. Until then, your child will get nutrition through 1 or more of these:

• A special tube that goes into a large vein. This is called a PICC line or peripherally inserted central catheter.
• A feeding tube that passes into their stomach through their nose (nasogastric tube or NG tube).
• A feeding tube through an opening in your child’s belly wall. After making the opening, the surgeon gently puts in a G tube or a device called a gastrostomy button. This is less common.

How long your child will need any of these devices depends on how their bowel heals after surgery. With a G tube or NG tube, your baby can still eat by mouth if they are able and, as needed, receive breast milk or formula through the feeding tube.

Our nurses and lactation specialists will do all that we can to support you in providing breastmilk for your baby. To keep your milk flowing and to build a milk supply for your baby, we help you with breast pumping and storing your milk. When your baby is ready, our nurses and feeding therapists help with the transition to feeding by bottle or breast.

Our nutritionists keep a careful watch on your baby to be sure they are growing well.

Your baby will stay in the hospital until they can feed well, poop normally and gain enough weight. Most children will stay in the hospital for 3 to 4 weeks. Some children stay longer, especially if they have other health problems.

By the time your baby leaves the hospital, their incision will be well healed. There are usually no restrictions on activity or bathing.

When your baby is ready to go home, they may still need medicine or a feeding tube in their nose for part of their nutrition. Our nurses will help set up the supplies and equipment you need. You will have plenty of time to practice all your baby’s care before going home. Most babies will be able to get all their feedings by mouth within a few months.

About 2 weeks after going home from the hospital, your child will see the surgeon and a dietitian for a follow-up visit. They will check to make sure:

• Your child is feeding well and gaining weight.
• The incision has healed.
• There are no other health issues.

If feeding by mouth is hard for your child, our occupational therapists can help. Other follow-up visits depend on your child’s health.