Umbilical hernia in newborns
The content of the article:
- Types of umbilical hernias in newborns
- Causes and risk factors
- Symptoms of an umbilical hernia in newborns
- Diagnostics
- Umbilical hernia treatment in newborns
- Potential consequences and complications
- Forecast
- Prevention
An umbilical hernia in newborns is a protrusion through the enlarged umbilical ring of some internal organs (intestinal loops, omentum). Umbilical hernia in newborns and children in the first years of life is often formed. According to statistics, the disease occurs in every fifth baby born on time and in every third premature baby. Among all types of hernial protrusions in children, umbilical ones account for 12-15%. In girls, umbilical hernia occurs several times more often than in boys.
The leading symptom of an umbilical hernia in a newborn is a slight swelling in the navel
Types of umbilical hernias in newborns
In newborns, there are two types of umbilical hernias:
- congenital, or embryonic (true, false);
- acquired.
Depending on the complications, umbilical hernias are reducible and non-reducible (restrained).
Causes and risk factors
After birth, a whole series of changes take place in the child's body, adapting it to extrauterine life. In particular, after the umbilical cord has fallen off, the walls of the umbilical ring close and gradually obliterate (become overgrown) with scar tissue. The lower part of the umbilical ring closes better, as it has a muscular membrane. There is no muscle layer in the upper part, and therefore it closes much worse, which creates the prerequisites for the formation of a hernia. Additional closure of the umbilical ring is largely facilitated by the muscles of the anterior abdominal wall. However, in newborns, their tone is still weak, therefore, any, and even more significant, increase in intra-abdominal pressure (straining, crying, coughing, sneezing) leads to exit through the enlarged umbilical ring into the peritoneal space of the peritoneum, omentum, intestinal loops. Over time, this mechanism leads to the formation of an umbilical hernia in newborns and children in the first years of life.
Crying, coughing in a newborn can provoke the development of an umbilical hernia due to a weak tone of the muscles of the abdominal wall
Predisposing factors for the formation of an umbilical hernia in newborns and infants are hereditary predisposition (the risk of developing the disease in a child whose parent suffered from it is over 70%), as well as diseases accompanied by a frequent increase in intra-abdominal pressure:
- phimosis;
- constipation;
- lactose intolerance;
- intestinal dysbiosis;
- bronchiolitis;
- pneumonia.
When coughing and straining, the abdominal organs penetrate through the umbilical ring into the umbilical tissue and gradually stretch it more and more.
Also, the formation of an umbilical hernia in newborns is predisposed by pathological conditions leading to a weakening of the muscle tone of the anterior abdominal wall:
- hypotrophy;
- congenital hypothyroidism;
- Down syndrome.
Acquired (postnatal) umbilical hernias begin to form during the neonatal period, but clinically they usually begin to appear somewhat later (from 2-3 months).
In addition to postnatal umbilical hernias, congenital (embryonic) hernias are also found in newborns. Another name for this type of hernia is omphalocele. They represent an anomaly in the development of the anterior abdominal wall, the consequence of which is the prolapse of internal organs into the umbilical cord. The disease occurs with a frequency of 1 in 3000-4000 births.
Omphalocele or embryonic umbilical hernia - an anomaly of the anterior abdominal wall
Negative factors affecting the body of a pregnant woman can provoke the formation of an embryonic umbilical hernia in a fetus:
- viral diseases (influenza, hepatitis, measles);
- pathologies of the course of pregnancy (disorders of the placental circulation, severe gestosis, anemia, cardiovascular disorders);
- smoking, including passive smoking;
- drinking alcoholic beverages;
- ionizing radiation;
- taking medications with teratogenic effects;
- living in an area with poor environmental conditions.
The formation of an embryonic hernia is associated with genetic disorders, since this deviation is a component of such genetically determined diseases as Edwards and Patau syndromes, as well as the OEIS-complex [O - omphalocele, E - ectopia of the bladder (that is, its location outside, and not inside the abdominal cavity), I - anus closure, S - spinal defects].
Symptoms of an umbilical hernia in newborns
The clinical picture of embryonic and postnatal hernias is different. Congenital umbilical hernias in newborns are detected immediately after the birth of the child. They are true and false. False hernias in essence represent the eventration of the abdominal organs, i.e., their prolapse. When examining a newborn, in this case, the liver and intestinal loops are found freely lying on the surface of the abdomen.
With true embryonic umbilical hernias in newborns, during the examination, internal organs located outside the abdominal cavity are found, which are covered from the outside with a translucent thin film. This film is fragile and can tear easily. In this case, the organs of the abdominal cavity come out.
Embryonic umbilical hernias in newborns are almost always combined with other developmental anomalies:
- Meckel's divetritculum;
- atresia of the anus;
- congenital intestinal obstruction;
- urachus cyst;
- splitting of the sternum;
- non-closure of the hard palate;
- non-closure of the upper lip;
- anomalies in the development of the diaphragm;
- ectopia of the bladder;
- congenital defects of the heart and great blood vessels;
- underdevelopment of the pubic articulation.
The leading symptom of an umbilical hernia in newborns that forms in the postnatal period is the appearance in the navel area of a small swelling that has an oval or round shape. Against the background of increased intra-abdominal pressure, this swelling increases in size, and at rest it decreases.
Acquired umbilical hernia in newborns and children of the first years of life usually does not cause discomfort to them. But sometimes, most often against the background of the progression of the disease and the achievement of a significant hernial protrusion, the child may experience cramping abdominal pain, nausea, and constipation. The newborn becomes restless - often cries, refuses to breast, sleeps poorly.
Postnatal umbilical hernia is clearly visible when the baby is crying
Infringement of umbilical hernias in newborns is extremely rare. If at the same time there is a compression of the intestinal area, then the hernial protrusion becomes sharply painful and uncontrollable. In addition, signs of an acute abdomen appear and grow in the child:
- repeated repeated vomiting;
- delay in passing gas and stool;
- cramping abdominal pain.
At the same time, the baby cries incessantly, pulls his legs to his stomach.
Diagnostics
Diagnosis of an umbilical hernia in newborns and children in the first years of life does not cause difficulties. During palpation of the abdomen, an enlarged umbilical ring is determined. You can notice the area of divergence of the rectus abdominis muscles and hernial protrusion by raising the head and torso of the newborn.
If there are indications for surgical treatment of an umbilical hernia in a newborn, a number of instrumental studies are performed:
- herniography (X-ray examination of the hernial sac with the introduction of a contrast agent into it);
- X-ray of the gastrointestinal tract organs using barium sulfate;
- survey radiography of the abdominal cavity;
- Ultrasound of the abdominal and pelvic organs.
Omphalocele is diagnosed at the stage of intrauterine development of the fetus
Embryonic umbilical hernias in most cases are diagnosed at the stage of intrauterine development of a child during a routine ultrasound examination.
Umbilical hernia treatment in newborns
Postnatal umbilical hernias in newborns in most cases pass on their own until the child reaches primary school age (6-7 years), therefore, in this case, expectant tactics is justified. To strengthen the abdominal muscles, it is recommended to lay the child on his stomach more often. Massage of the anterior abdominal wall regularly carried out with an umbilical hernia of a newborn also speeds up the healing process.
In some cases, the doctor may prescribe the wearing of an umbilical hernia bandage in newborns or a tightening adhesive bandage.
When the child grows up, swimming in the pool and physical therapy will help to strengthen the muscles of the anterior abdominal wall.
With an umbilical hernia, the newborn may be prescribed wearing a special bandage
Indications for surgery for an umbilical hernia in a newborn are:
- infringement of a hernia;
- digestive disorders;
- significant size of the hernial protrusion.
During the surgical intervention, the surgeon returns the internal organs to the abdominal cavity, excises the hernial sac, and then performs plastic (suturing and strengthening) of the expanded umbilical ring. The operation takes 30-40 minutes. If the child is in good condition, he is discharged from the hospital the next morning.
When an umbilical hernia is infringed in newborns, the necrotic portion of the intestine is removed (resected) with subsequent restoration of its integrity (end-to-end or end-to-side). After that, they proceed to excision of the hernial sac and plasty of the hernial orifice (umbilical ring).
Removal of umbilical hernia in newborns is carried out with infringement, large size, indigestion
With an embryonic umbilical hernia of newborns, treatment consists of surgical intervention, which is performed on the first day of the child's life.
Potential consequences and complications
The most dangerous complication of embryonic umbilical hernia in newborns is rupture of the membranes that form the hernial sac. As a result, an infection enters the abdominal cavity, leading to the development of diffuse peritonitis - a deadly disease.
Infringement of postnatal umbilical hernia in newborns is accompanied by necrosis of the intestinal area and the development of mechanical intestinal obstruction, which, in turn, is complicated by diffuse peritonitis.
Forecast
The prognosis for embryonic umbilical hernias in newborns, especially if they are combined with other anomalies in the development of internal organs, is unfavorable - 60-70% of cases end with a fatal outcome, even with timely treatment.
Postnatal umbilical hernias in newborns are favorable. As a rule, they do not give unpleasant sensations to children and pass on their own as the child grows up.
Planned hernia repair, performed according to indications, is rarely accompanied by complications. The rehabilitation period is short. With emergency surgical interventions associated with infringement of the umbilical hernia in newborns, the prognosis worsens.
Relapses rarely occur after the disease is removed.
Prevention
To prevent the formation of umbilical hernias in newborns, it is necessary to carry out activities aimed at strengthening the muscles of the anterior abdominal wall of the child:
- massage;
- physical therapy classes;
- frequent spreading on the stomach;
- swimming.
It is very important to timely treat diseases that are accompanied by an increase in intra-abdominal pressure (bronchiolitis, pneumonia, constipation or diarrhea).
Prevention of embryonic hernias consists in measures that ensure the normal course of pregnancy (proper nutrition, good rest, rejection of bad habits, a healthy environment, prevention of viral infection). In the presence of a burdened heredity, a couple is recommended genetic counseling at the stage of pregnancy planning.
YouTube video related to the article:
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
