CARE OF AN INFANT

WITH
BIRTH DEFECTS
Cleft Lip and Palate
 Cleft Lip (cheiloschisis)
• The infant with cleft lip, the fusion fails to
occur in varying degrees, causing this
disorder to range from a small notch in the
upper lip to total separation of the lip and
facial structure up into the floor of the nose,
with even the upper teeth and gingiva
absent….
 Cleft Lip
• Is more prevalent among boys than girls.

• It occurs at a rate of approximately 1 in

every 750 live births.
 Cleft Lip
• Occurs as a familial tendency or most
likely occurs from the transmission of
multiple genes.
Risk Factors (Cleft Lip)

Teratogenic factors
• viral infection
• deficiency of folic acid.
• Parents of a child with a cleft lip should be
referred for genetic counseling to ensure
they understand that they have about 4%
chance of having another child with a cleft
lip or cleft palate.
 Cleft Palate (palatoschisis)
• An opening of the palate
• It is usually on the midline and may involve
the anterior hard palate, the posterior soft
palate, or both.
 Cleft Palate
• Is more prevalent among girls than boys.

• In connection with cleft lip, the incidence is

approximately 1 in every 1, 000 births
 Assessment
• Cleft lip may be detected by a sonogram
while the infant is in the utero.

• Cleft palate can be determined by

depressing the newborn’s tongue with a
tongue blade....
 Therapeutic Management
• A cleft lip is repaired surgically shortly after birth,
sometimes at a time of the initial hospital stay or
between 2 and 10 weeks of age... (cheiloplasty)

• Repair of cleft palate is usually postponed until a child is

6 to 18 months old to allow anatomic change in the
palate contour that occur during the first year of life take
place....( palatoplasty)
• The result of surgical repair of cleft lip and
cleft palate are EXCELLENT.
Imperforated
Anus
 What is imperforate anus?
• Imperforate anus occurs when the anal
opening is absent or not in a normal
position.
• It is a birth defect caused by the failure of
normal development of the anal area.
• Sometimes an abnormal opening (fistula)
is present between the bowel and the
vagina in girls, or between the bowel and
the urinary tract in boys.
 There are two types of imperforate
anus:
High type
• no opening is present and the bowel ends
above the muscles at the bottom of the
pelvis.
Low type
• the bowel ends below the muscles at the
bottom of the pelvis. There is often an
opening present, but it is in an abnormal
position or is covered by a membrane.
 What causes an
imperforate anus?

• There is no known cause for the condition,

• which occurs in 1 out of every 5,000
infants.
 What are the symptoms?
• no anal opening
• misplaced anal opening
• anal opening very near the vaginal
opening in a female
• no bowel movement within 24 to 48 hours
after birth
• stool passed through the vagina or urethra
• abdominal distension
 How is it diagnosed?

• Diagnosis is made at birth when the anal

opening is checked during the newborn’s
physical examination.
 What is the treatment?
The low type may be corrected by one or
more of the following:
• opening the membrane in surgery
• repeated dilating (stretching) of the
opening
• surgical reconstruction
• The high type is corrected by creating a
temporary colostomy (re-routing the bowel
out through the abdominal wall). The baby
then has bowel movements into a pouch
(bag).
• At about 6 to 12 months of age, surgical
reconstruction of an anal opening is
performed, and any possible fistula is
closed. The colostomy is reconnected 6 to
8 weeks later.