Jejunal Atresia

Jejunal atresia is a birth problem where a section of the middle small intestine (the jejunum) is blocked or missing. Because the tube is closed, milk cannot pass through, so newborns quickly develop green (bilious) vomiting, a swollen belly, and they do not pass stool. Doctors confirm the blockage with imaging and careful exam, then fix it with surgery by removing the blocked part and joining the healthy ends. With modern care, most babies do well, but some need extra nutrition for a while and careful follow-up. The main cause is thought to be a loss of blood flow to the intestine while the baby is in the womb, which damages that segment. Jejunal atresia is part of a group called jejunoileal atresia, one of the most common reasons for bowel blockage in newborns. NCBI+2Medscape+2 Types and special forms include simple membrane blockage, gaps with a cord, complete breaks with missing mesentery, and the rare “apple-peel” (type IIIb) where the remaining small bowel coils like a spring and gets blood from a single vessel. Surgeons use the type to plan the operation, but the basic goal—remove the blocked area and reconnect healthy bowel—remains the same. Medscape+1

Jejunal atresia is a birth defect where a part of the small intestine—the jejunum—is blocked or completely closed. Because the passage is blocked, milk cannot move forward. A newborn then develops swelling of the belly, green (bilious) vomiting, and does not pass the first stool (meconium). Jejunal atresia is part of a broader group called jejunoileal atresia (JIA), which includes blockages in the jejunum or the ileum. Doctors consider it a surgical emergency in newborns because the baby cannot feed until the blockage is fixed. The blockage usually forms before birth due to a problem with blood supply to that section of intestine while the baby is developing in the womb. After birth, X-rays often show a classic “triple bubble” sign when the atresia is high in the small bowel, and contrast studies may show a tiny unused colon (microcolon). Treatment is surgery to remove or reshape the blocked segment and join the healthy ends. With modern care, most babies do well. Medscape+2Radiopaedia+2

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Other names

• Jejunoileal atresia (JIA) – umbrella term used by surgeons; many papers discuss jejunal and ileal atresia together because they behave similarly. NCBI

• Intestinal atresia (jejunal type) – broader phrase that points to location within the small bowel. Medscape

• Type IIIb (“apple-peel” or “Christmas-tree”) atresia – a special pattern where the remaining small bowel coils around a single artery; often proximal jejunum is affected. Medscape

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Pathophysiology

Inside the womb, a section of the developing small intestine may temporarily lose its blood supply. Without enough blood, that segment can narrow, scar shut, or even disappear. Later, the baby is born with a gap or a tight membrane that blocks flow. This vascular disruption model explains why jejunal atresia often occurs as a single, isolated problem and why some babies have the “apple-peel” pattern where the main artery is missing and the bowel spirals around a small vessel. Factors that tighten blood vessels (vasoconstrictors) in pregnancy, such as cocaine or heavy smoking or certain decongestants, have been linked in studies to intestinal atresia and the related defect gastroschisis. Medscape+2PubMed+2

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Types

Doctors classify jejunoileal/jejunal atresia into standard types based on how the bowel looks in surgery. Knowing the type helps plan the repair and predict recovery.

1. Type I (membranous atresia). The outside of the bowel looks normal, but a thick membrane blocks the inside. Surgeons open the bowel and remove the membrane or resect a short segment, then reconnect. Babies tend to recover well if no other issues exist. Medscape

2. Type II (fibrous cord between ends). The upstream and downstream ends are connected by a thin cord, but the hollow channel is not continuous. Surgeons remove the cord and join the two open ends. Medscape

3. Type IIIa (gap with mesenteric defect). The two ends are separated with a triangular gap in the mesentery (the tissue that carries blood to intestine). Repair requires removing damaged bowel and bridging the gap. Medscape

4. Type IIIb (“apple-peel”). A severe form: the proximal jejunum ends blindly; the rest of the small bowel is narrow and coils around a single artery; part of the mesentery and the distal superior mesenteric artery are absent. This type often needs careful surgery and may be associated with shorter total bowel length. Medscape

5. Type IV (multiple atresias). There are several separate blockages along the small intestine, giving a “string of sausages” look. Surgeons may need to repair several spots while preserving as much length as possible. Medscape

Most babies have no major problems outside the intestine, but some have gastroschisis, malrotation, or cystic fibrosis, and a few show meconium peritonitis (calcifications) on X-ray. Trisomy 21 (Down syndrome) is strongly linked to duodenal atresia but is uncommon in jejunoileal atresia. Very rare genetic syndromes like Strømme syndrome can include an “apple-peel” atresia pattern. NCBI+3Merck Manuals+3aps-journal.org+3

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Causes

Important note: In most cases we cannot point to a single cause in one baby. These are known or suspected risk mechanisms or associations that support the vascular disruption explanation.

1. In-utero vascular accident (primary cause). A temporary loss of blood flow to a short segment of jejunum during fetal life can make that segment close or vanish, leaving a blockage at birth. Medscape

2. Mesenteric interruption in type IIIb (“apple-peel”). Missing or underdeveloped branches of the superior mesenteric artery deprive the distal bowel of flow, producing the classic spiral “apple-peel” bowel. Medscape

3. Mid-gut volvulus before birth. A twist of the intestine can block its blood vessels long enough to create an atresia even before delivery. jpnim.com

4. In-utero intussusception. One segment of bowel telescopes into another, trapping its blood supply and causing the trapped part to die and resorb, leaving an atresia. Medscape

5. Internal hernia or bands. Herniation or tight bands can pinch a mesenteric vessel, leading to a localized atresia. Medscape

6. Vasoconstrictive drug exposure (e.g., cocaine). Maternal cocaine use can cause fetal vascular spasm and has been associated with limb reduction and intestinal atresia in case series. PubMed

7. Cigarette smoking and decongestants. Studies linking cigarette smoking and vasoconstrictive medications during pregnancy show higher risk of small intestinal atresia and gastroschisis, supporting a vascular mechanism. PubMed

8. Combined recreational drug use. Broader epidemiologic work suggests recreational drug exposure increases vascular-disruption defects; although not specific, this supports risk for atresia. Oxford Academic

9. Meconium peritonitis with bowel injury. Inflammation and perforation before birth can scar and close a segment; this is often seen alongside calcifications on imaging. Radiology Assistant

10. Gastroschisis-related vascular compromise. Babies with gastroschisis can have compromised mesenteric blood flow, and small bowel atresias are more frequent in this group. PubMed

11. Inherited or familial tendency (rare). Familial clusters exist, suggesting a genetic contribution in a small subset; most cases remain sporadic. jpnim.com

12. Associated cystic fibrosis (CF). CF does not cause atresia directly, but thick meconium and in-utero inflammatory changes can coexist; clinicians often check for CF in JIA. Merck Manuals

13. Malrotation with episodic ischemia. Abnormal positioning of the bowel can predispose to twisting and vascular compromise during fetal life. Merck Manuals

14. Congenital diaphragmatic hernia (rare association). Case reports describe duodenal/jejunal atresia with diaphragmatic hernia, reinforcing the vascular theory. secipe.org

15. Chromosomal anomalies (uncommon in JIA). Unlike duodenal atresia, large chromosomal syndromes are uncommon in JIA, which fits a late, localized vascular event rather than a primary patterning defect. aps-journal.org

16. Maternal thrombophilia (proposed). Some reports discuss inherited tendencies to clotting as a possible contributor to fetal mesenteric vascular events. Evidence is limited but plausible. jpnim.com

17. Annular pancreas with vascular issues (case-report level). Rarely, an annular pancreas and absent SMA branches were found together with apple-peel anatomy, highlighting complex vascular interplay. PubMed

18. Umbilical–placental vascular events. Global placental vascular problems (e.g., abruption) from substances like cocaine can set the stage for broader fetal vascular compromise, though not specific to atresia. MSD Manuals

19. Utero-placental insufficiency with fetal hypotension (theoretical). Any state that reduces fetal intestinal perfusion for long enough could contribute to segmental loss and atresia; this is a mechanism-based inference from the vascular model. Medscape

20. Multiple sequential vascular hits (for type IV). When there are several blockages (type IV), surgeons suspect repeated small vascular insults at different times during gestation. Medscape

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Symptoms and signs

Before birth (prenatal clues)

1. Polyhydramnios. Extra amniotic fluid builds up because the fetus cannot absorb swallowed fluid; seen in many small-bowel obstructions but not specific. OBGYN

2. Dilated bowel loops on ultrasound. One or a few enlarged fluid-filled loops suggest obstruction; accuracy is limited, so doctors combine this with other findings and follow-up scans. PMC+1

After birth (typical presentation)

3. Green (bilious) vomiting. Bile backs up when the blockage is below the stomach and duodenum; this is a key warning sign in any newborn. Medscape

4. Abdominal distension. Swelling of the belly happens as gas and fluid collect above the blockage. Medscape

5. Failure to pass meconium. The baby does not pass the first stool in the usual time frame because the distal bowel is unused (often a microcolon). Radiology Assistant

6. Feeding intolerance. Attempts to feed lead to vomiting and worsening bloating, so feeds are stopped and a nasogastric tube is placed. ScienceDirect

7. Dehydration. Repeated vomiting and third-spacing of fluid into the bowel cause low body water and dry mouth, needing IV fluids. Medscape

8. Electrolyte imbalance. Loss of gastric and intestinal fluids alters sodium, chloride, and potassium levels; labs guide correction before surgery. Medscape

9. Sunken fontanelle or poor skin turgor. Physical signs of dehydration may be seen on exam. Medscape

10. Visible peristalsis. You may see waves on the abdominal wall as the bowel struggles to push against the blockage. Medscape

11. Minimal or no stooling after birth. The diaper remains clean of meconium beyond the expected timeframe unless a tiny amount leaks around the blockage. Medscape

12. Abdominal tenderness or irritability. The baby may be fussy due to bowel distension or, rarely, meconium peritonitis. Radiology Assistant

13. Abdominal calcifications on X-ray (meconium peritonitis). If there was a prenatal perforation, white specks of calcium may be visible. Radiology Assistant

14. Poor weight gain if presentation is delayed. Rare late or partial cases may present later with poor growth or chronic vomiting. ScienceDirect

15. Bile-stained nasogastric aspirates. When a tube is placed, green fluid returns, supporting a distal obstruction. Medscape

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Diagnostic tests

A) Physical examination

1. General newborn exam. Doctors look for dehydration, jaundice, or other anomalies (e.g., gastroschisis), and check the anus is open to rule out anorectal malformations. Findings guide urgency and safety of surgery. Merck Manuals

2. Abdominal inspection and palpation. A distended, tympanitic abdomen suggests obstruction; tenderness raises concern for perforation or peritonitis. Medscape

3. Auscultation of bowel sounds. High-pitched or tinkling sounds can occur with obstruction; silence suggests ileus or severe compromise. Medscape

4. Assessment of meconium passage. Lack of meconium (or only a smear) supports a distal obstruction; correlates with imaging. Radiology Assistant

5. Hydration status assessment. Fontanelle, mucous membranes, and capillary refill help estimate fluid deficits to correct before anesthesia. Medscape

B) “Manual bedside procedures

6. Nasogastric (NG) tube placement. The tube decompresses the stomach, prevents aspiration, and allows measurement of bilious output, which supports the diagnosis while stabilizing the baby. Medscape

7. Gentle rectal exam. Confirms the anus is patent and may produce a small meconium smear; this helps differentiate distal obstruction types. Medscape

8. Stomach/upper gut decompression and monitoring. Continuous low suction through the NG tube reduces distension and vomiting while imaging is arranged. Medscape

9. Bedside abdominal girth measurement. Serial girth checks track distension in the NICU while awaiting surgery. (Supportive, not diagnostic alone.) Medscape

10. Temperature and cardiorespiratory monitoring. Obstructed neonates can become unstable quickly; monitoring informs timing of the operation. (Supportive test.) Medscape

C) Laboratory and pathological tests

11. Serum electrolytes and glucose. Identify dehydration and electrolyte losses from vomiting to correct pre-op (e.g., sodium, potassium, chloride, bicarbonate). Medscape

12. Complete blood count (CBC). Checks for anemia or infection markers (elevated WBC) if perforation or peritonitis is suspected. Medscape

13. Blood gas (venous or arterial). Assesses acid-base status and perfusion; metabolic alkalosis can occur with gastric fluid loss. Medscape

14. Type and crossmatch. Prepares for surgery where transfusion might be needed; a standard safety step. Medscape

15. Cystic fibrosis testing (as indicated). Because JIA sometimes co-exists with CF or meconium obstruction, clinicians may order CFTR testing or a newborn screen review. Merck Manuals

D) Electro-diagnostic / physiologic monitoring

These are supportive rather than primary diagnostic tests for atresia, but they are important in evaluation and peri-operative safety.

16. Electrocardiogram (ECG). Screens for rhythm problems and guides anesthesia in fragile neonates. (Supportive) Medscape

17. Pulse oximetry. Continuous oxygen saturation monitoring detects respiratory compromise from aspiration risk or abdominal distension. (Supportive) Medscape

18. Capnography during anesthesia. Ensures safe ventilation and detects sudden changes intra-operatively; standard peri-operative care in neonatal surgery. (Supportive) Medscape

E) Imaging tests

19. Plain abdominal X-ray (radiograph). Often shows the classic “triple bubble” pattern (stomach + duodenum + proximal jejunum) with little or no gas beyond, strongly suggesting proximal jejunal atresia. Radiopaedia+1

20. Contrast enema. Fills the colon from below. In jejunal or ileal atresia, the colon is tiny (microcolon) because it has not been used in utero; this helps confirm a high small-bowel obstruction and map the level. Radiopaedia+1

21. Upper GI contrast study (as needed). If malrotation with volvulus is a concern, contrast through the stomach/duodenum checks the position of the duodenojejunal junction and can help exclude volvulus. ScienceDirect

22. Prenatal ultrasound. Shows dilated bowel loops and sometimes polyhydramnios; useful for planning delivery at a surgical center, though its accuracy is limited and depends on timing. OBGYN+1

23. Prenatal MRI (selected cases). May help characterize dilated bowel and exclude other causes if ultrasound is unclear; used in specialized centers. (General imaging principle in neonatal obstruction reviews.) RSNA Publications

24. Ultrasound for ascites/calcifications. Can show free fluid or echogenic foci from meconium peritonitis, which hints at prenatal perforation. Radiology Assistant

25. Follow-up post-op contrast studies (if feeding issues). Used selectively to check anastomosis patency if a baby has prolonged intolerance after repair. ScienceDirect

Non-pharmacological treatments (therapies & other measures)

1. Immediate bowel rest with nasogastric (NG) decompression. A soft tube removes stomach and upper-intestinal fluid to prevent vomiting and reduce swelling. This lowers the risk of aspiration and helps stabilize the baby before surgery. Medscape

2. Isotonic intravenous fluids and electrolyte correction. Babies lose fluids into the blocked bowel and by vomiting; IV fluids restore circulation and correct salt imbalances to prepare for anesthesia and surgery. Medscape

3. Thermal regulation and gentle handling. Keeping the newborn warm and minimizing stress preserves energy and stabilizes vital signs during pre-op care. It is part of standard neonatal surgical optimization. Medscape

4. Oxygen and cardiorespiratory support if needed. Some infants require supplemental oxygen or supported breathing; stabilization follows general neonatal resuscitation principles prior to OR transfer. Medscape

5. Preoperative evaluation and imaging. Abdominal radiographs (babygram) and, when indicated, contrast studies help confirm obstruction level and guide surgical planning. Pediatric Surgery Library

6. Family counseling and multidisciplinary planning. Surgeons, neonatologists, anesthetists, and dietitians discuss the plan, recovery, and feeding pathway with the family to set expectations and improve outcomes. Medscape

7. Early surgery (definitive repair). The core therapy is timely resection of atretic bowel with primary anastomosis when feasible; this removes the block and restores flow. NCBI+1

8. Tapering enteroplasty (when proximal bowel is very dilated). If the bowel above the blockage is too wide and sluggish, surgeons may “taper” it so it matches the normal size below and empties better. Medscape

9. Selective stoma creation. In complicated cases (multiple atresias, poor bowel condition, very low birthweight), a temporary ostomy may be safer before final reconnection. Medscape

10. Enhanced Recovery After Surgery (ERAS-Neonates) bundle. Evidence-based elements—minimal fasting, careful fluids, early pain control, early enteral nutrition—improve recovery and reduce complications. PMC

11. Early, structured enteral feeding after surgery. Stepwise breast milk or formula feeds, guided by standardized protocols, speed bowel recovery and shorten hospital stay. PubMed+1

12. Parenteral nutrition (PN) when feeds are not yet tolerated. IV nutrition covers calories, protein, fats, vitamins, and minerals to support healing and growth until the gut is ready. AAP Publications+1

13. Lactation support and expressed human milk use. Human milk is easier to digest and supports gut immunity; providing pumped milk helps earlier transition to full enteral feeds. PMC

14. Human milk fortification (when indicated). Fortifiers can be added later to meet higher protein and mineral needs during catch-up growth under clinical guidance. members.naspghan.org

15. Central venous catheter care protocols. When PN is needed, strict line-care bundles minimize bloodstream infections and clotting. ESPN

16. Electrolyte, micronutrient, and vitamin monitoring. Regular labs guide PN adjustments (including thiamine and trace elements) to avoid deficiencies or toxicity. ESPN

17. Physiotherapy and positioning for comfort and breathing. Gentle neonatal physio and proper positioning reduce atelectasis risk and improve overall stability during recovery. PMC

18. Wound care and infection-prevention practices. Hand hygiene, temperature maintenance, and careful dressing changes lower surgical-site infection risk. PMC

19. Intestinal rehabilitation follow-up (if bowel length is limited). Specialized teams optimize nutrition, reduce PN dependence, and monitor growth in babies at risk for short bowel syndrome. Wiley Online Library

20. Structured discharge planning and growth surveillance. Clear feeding plans, vitamin/mineral supplementation as needed, and regular clinic checks ensure steady growth and early detection of problems. AAP Publications

Drug treatments

Important: Drug choices and doses in neonates are highly individualized. The following reflect common options reported in pediatric-surgery and NICU literature; exact dosing/timing must follow local neonatal formularies and clinician judgment.

1. Cefazolin (peri-operative prophylactic antibiotic; 1st-gen cephalosporin).
   Dose/Time: Single pre-incision dose; sometimes ≤24 h coverage.
   Purpose/Mechanism: Prevents skin-flora surgical-site infection by inhibiting bacterial cell-wall synthesis.
   Side effects: Allergic reactions, GI upset; rare C. difficile. Evidence suggests very short courses are sufficient after neonatal enteric operations. jpedsurg.org

2. Ampicillin + Gentamicin (empiric broad-spectrum when bowel compromise suspected; penicillin + aminoglycoside).
   Dose/Time: Weight/age-adjusted; started pre-op if ischemia/perforation risk.
   Purpose/Mechanism: Gram-positive (ampicillin) and Gram-negative (gentamicin) coverage for translocation/sepsis.
   Side effects: Nephro/ototoxicity (gentamicin—level monitoring), allergy. Medscape

3. Metronidazole (anaerobe coverage when perforation/necrosis suspected).
   Dose/Time: Added to empiric regimen if concern for anaerobes.
   Purpose/Mechanism: Disrupts DNA in anaerobic bacteria.
   Side effects: Nausea, rare neurotoxicity with prolonged use. PMC

4. Piperacillin-tazobactam (broad empiric alternative; extended-spectrum penicillin + β-lactamase inhibitor).
   Dose/Time: NICU-adjusted; used when high Gram-negative/anaerobe risk.
   Purpose/Mechanism: Cell-wall inhibition plus β-lactamase blockade; wide coverage.
   Side effects: Electrolyte load (sodium), allergy, GI upset. Medscape

5. Acetaminophen (paracetamol; non-opioid analgesic/antipyretic).
   Dose/Time: Scheduled post-op analgesia per NICU protocol.
   Purpose/Mechanism: Central COX inhibition to reduce pain and discomfort.
   Side effects: Hepatotoxicity at excess doses—strict neonatal dosing vital. PMC

6. Fentanyl (opioid analgesic).
   Dose/Time: Intra- and early post-op pain control via infusion/bolus.
   Purpose/Mechanism: μ-opioid receptor agonist for strong analgesia.
   Side effects: Respiratory depression, chest wall rigidity at high doses—monitor closely. PMC

7. Morphine (opioid analgesic).
   Dose/Time: Alternative to fentanyl per center practice.
   Purpose/Mechanism: μ-opioid agonist; sustained analgesia.
   Side effects: Respiratory depression, hypotension, ileus—careful titration in neonates. PMC

8. Local anesthetic wound infiltration/blocks (e.g., bupivacaine).
   Dose/Time: At wound closure for opioid-sparing pain control.
   Purpose/Mechanism: Sodium-channel blockade reduces incisional pain.
   Side effects: Rare systemic toxicity if overdose—dose by weight. PMC

9. Proton-pump inhibitor (e.g., pantoprazole) or H2 blocker (center-specific).
   Dose/Time: Short course post-op in select infants at high risk of stress ulceration or severe reflux as directed by team.
   Purpose/Mechanism: Reduce gastric acid secretion to protect mucosa.
   Side effects: Altered microbiome, possible infection risk—use only if indicated. Medscape

10. Ondansetron (antiemetic).
    Dose/Time: Limited neonatal use; sometimes used post-op per specialist judgment.
    Purpose/Mechanism: 5-HT3 receptor blockade to reduce vomiting.
    Side effects: QT prolongation—use cautiously and only if clearly needed. Medscape

11. Heparin (line patency in PN; low-dose).
    Dose/Time: Added to central line infusions to reduce clotting per protocol.
    Purpose/Mechanism: Anticoagulation at catheter tip.
    Side effects: Bleeding risk—strict dosing and monitoring. ESPN

12. Inotropes (e.g., dopamine) if shock.
    Dose/Time: ICU titration for babies with hemodynamic instability.
    Purpose/Mechanism: Improve perfusion while fluids and correction continue.
    Side effects: Arrhythmias, vasoconstriction—ICU monitoring essential. Medscape

13. Parenteral amino acids (PN component).
    Dose/Time: Start soon after surgery if enteral feeds are delayed; dosage per PN pathway.
    Purpose/Mechanism: Provide building blocks for growth and wound healing.
    Side effects: Azotemia if excessive; adjust to labs. UC Davis Health

14. Intravenous lipid emulsions (e.g., mixed-oil/SMOF or fish-oil-containing).
    Dose/Time: Part of PN to deliver essential fatty acids and calories; fish-oil formulations may help limit liver complications during prolonged PN.
    Side effects: Hypertriglyceridemia, cholestasis—monitor. ESPN

15. Electrolytes and minerals (PN: sodium, potassium, calcium, phosphorus, magnesium).
    Dose/Time: Daily PN adjustments based on labs.
    Purpose/Mechanism: Maintain homeostasis and bone mineralization.
    Side effects: Derangements if over/under-replaced; careful monitoring needed. East of England

16. Water-soluble vitamins (with emphasis on thiamine) in PN.
    Dose/Time: Included daily; thiamine deficiency can occur quickly without supplementation.
    Purpose/Mechanism: Co-factors for energy metabolism; thiamine prevents lactic acidosis.
    Side effects: Rare with standard PN dosing. ESPN

17. Fat-soluble vitamins (A, D, E, K) in PN.
    Dose/Time: Daily PN dosing per neonatal guidance; vitamin D reassessed during enteral transition.
    Purpose/Mechanism: Vision/epithelium (A), bone (D), antioxidant (E), clotting (K).
    Side effects: Accumulation if excessive—dose carefully. ESPN

18. Trace elements (zinc, copper, selenium, manganese) in PN.
    Dose/Time: Standard PN micro-mix adjusted to cholestasis status (e.g., copper/manganese reduction if needed).
    Purpose/Mechanism: Enzyme function and growth.
    Side effects: Deficiency or toxicity if misdosed. ESPN

19. Prophylactic antibiotics—short duration only.
    Dose/Time: As above, evidence supports limiting to a single peri-op day in many neonatal enteric operations to reduce harm.
    Purpose/Mechanism: SSI prevention without prolonged exposure.
    Side effects: Resistance, microbiome disruption—hence “short and smart.” jpedsurg.org

20. Vitamin K at birth (standard neonatal care).
    Dose/Time: Single prophylactic dose shortly after delivery (before or after surgical diagnosis) to prevent bleeding disorders.
    Purpose/Mechanism: Restores clotting factor activation.
    Side effects: Very rare reactions. Standard of care in neonates. Medscape

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Dietary molecular supplements

In newborns, “supplements” means nutrients provided via PN or medically supervised feeds; over-the-counter products are not used. Doses are individualized in PN pathways.

1. Amino acids (PN). Supply protein for healing and growth when oral feeds aren’t possible; adjusted daily to labs and tolerance. UC Davis Health

2. Intravenous lipids (mixed-oil/fish-oil-containing). Provide dense calories and essential fatty acids; certain emulsions may lower liver complications during long PN. ESPN

3. Glucose (dextrose in PN). Main energy source; GIR titrated to avoid hypo-/hyperglycemia. UC Davis Health

4. Thiamine and B-complex vitamins. Prevent acute deficiency (e.g., lactic acidosis) during PN; included in standard PN mixes. ESPN

5. Vitamin D. Supports bone mineralization; later maintained via enteral regimen as feeds advance. ESPN

6. Trace elements (zinc, selenium, copper, manganese). Critical for enzymes, immunity, and growth; adjusted if cholestasis develops. ESPN

7. Electrolytes (Na, K, Ca, Mg, Phos). Essential for fluid balance, muscle and heart function, and bone; PN and feeds are tailored to labs. East of England

8. Human milk fortifier (later enteral phase). Adds protein/minerals to expressed milk to meet higher needs during catch-up growth. members.naspghan.org

9. Carnitine (select PN protocols). May be added during longer PN courses per NICU pathway; supports fatty-acid transport/oxidation. Johns Hopkins Medicine

10. Phosphate and calcium optimization. Prevents metabolic bone disease during prolonged PN; balanced with vitamin D status. UC Davis Health

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Immunity-booster / regenerative / stem-cell drugs

There are no approved immune-booster drugs, regenerative medicines, or stem-cell therapies for treating jejunal atresia. The proven treatment is surgery plus excellent neonatal intensive care and nutrition. Any experimental cell-based therapy for neonatal gut conditions remains research-only and is not standard or recommended outside clinical trials. NCBI+1

Instead, teams focus on: timely surgery, human milk when possible, careful PN, infection prevention, vaccines on the regular schedule as the child grows, and close growth/development follow-up. PMC+1

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Surgeries

1. Resection with primary anastomosis. The surgeon removes the blocked/abnormal segment and sews the healthy ends together to restore intestinal flow—the standard repair in most cases. NCBI+1

2. Tapering enteroplasty. If the upstream bowel is very dilated and weak, it is narrowed so it can push milk forward effectively after reconnection. Medscape

3. Temporary enterostomy (stoma). In complex disease (multiple atresias, poor bowel condition, prematurity) a stoma diverts stool to allow healing; later, the ends are rejoined. Medscape

4. Management of “apple-peel” (type IIIb) atresia. Specialized reconstruction is required due to the single blood supply and coiled bowel; staged strategies may be used. Radiopaedia+1

5. Central venous catheter placement for PN (supporting procedure). Provides safe long-term IV access for nutrition and medications during recovery. ESPN

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Preventions

Most cases are not preventable, as they arise from in-utero vascular events we cannot predict. Still, general steps that support healthier pregnancies and safer neonatal care include: early prenatal care and scans; avoiding tobacco, cocaine, and harmful drugs; managing maternal illnesses; delivering in or transferring to centers with neonatal surgery; rapid post-birth recognition of bilious vomiting; early NG decompression and IV fluids; preventing hypothermia; timely antibiotics only when indicated; and standardized ERAS-Neonates and feeding protocols to lower complications. PubMed+4Pediatric Surgery Library+4Medscape+4

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When to see a doctor

• During pregnancy: If ultrasound suggests bowel blockage (dilated loops, polyhydramnios), ask for referral to a fetal-maternal and pediatric-surgery team to plan delivery and immediate care. Pediatric Surgery Library

• After birth: Bilious (green) vomiting, swollen belly, or failure to pass meconium in the first day are emergencies—seek immediate neonatal evaluation and surgical consultation. Medscape

• After repair: Return urgently for vomiting that turns bilious, poor weight gain, fever, wound problems, dehydration, or feeding intolerance—these may signal obstruction, infection, or nutrient issues needing prompt care. Medscape

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What to eat / what to avoid

Always follow your surgeon’s and NICU dietitian’s plan—feeding is individualized.

1. Start with human milk if available. It’s gentle and supports gut healing; expressed milk is great while baby learns to feed. PMC

2. Advance slowly and stepwise. Volumes rise per protocol as the baby shows good tolerance (no green vomiting, soft belly, stooling). PubMed

3. Use specialized formulas if advised. Some infants need easily digested formulas for a time. AAP Publications

4. Fortify when needed. Extra protein/minerals can be added later to meet growth targets. members.naspghan.org

5. Avoid over-feeding early. Too much, too fast can cause vomiting and distension—follow the daily plan. Frontiers

6. Keep baby upright during and after feeds. Positioning may reduce reflux and improve comfort. PMC

7. Monitor hydration. Report fewer wet diapers, dry lips, or lethargy—these can mean dehydration. Medscape

8. If PN continues at home (rare), follow line-care and mixing instructions exactly to avoid infections or line problems. ESPN

9. Recheck vitamins/minerals as advised. The team may adjust vitamin D, iron, or trace elements during growth. ESPN

10. Avoid over-the-counter “supplements.” Do not give teas, herbal products, probiotics, or vitamins unless the neonatal team prescribes them. Medscape

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Frequently asked questions (FAQs)

1. What causes jejunal atresia?
   Most likely a loss of blood flow to part of the baby’s intestine while in the womb; that segment then scars closed or is resorbed. It is usually not inherited and not caused by anything the mother did. Pediatric Surgery Library

2. How is it diagnosed?
   Doctors suspect it from newborn symptoms (bilious vomiting, no stool) and X-rays; sometimes ultrasound hints during pregnancy. Surgery confirms and treats it. Medscape

3. Is surgery always needed?
   Yes—there is no medicine that opens a completely blocked intestine. Surgery removes the blockage and reconnects healthy bowel. NCBI

4. What happens right after birth?
   The team keeps the baby NPO (nothing by mouth), places an NG tube to drain, gives IV fluids, and prepares for surgery once stable. Medscape

5. How soon can my baby eat after surgery?
   Many centers start small amounts of milk early using stepwise protocols; this can speed recovery when the baby shows readiness. PN covers needs until full feeds are reached. PubMed+1

6. What if a lot of bowel had to be removed?
   If bowel length is short, an intestinal rehabilitation program supports growth, reduces PN time, and monitors for liver or nutrient issues. Wiley Online Library

7. What is “apple-peel” atresia?
   A rare, complex form where the remaining bowel coils and has a single blood supply; repairs may be staged and need expert care. Radiopaedia

8. Do antibiotics continue for days after surgery?
   Often not. Studies show that a single peri-operative day can be enough in many neonatal enteric surgeries, lowering risks from longer courses. jpedsurg.org

9. Can my baby breastfeed?
   Yes, many babies transition to breast milk; lactation support and expressed milk help until direct feeding is safe. PMC

10. Are there long-term problems?
    Most children do well. Some have reflux, feeding intolerance, or slower weight gain for a while; your team will monitor growth closely. Medscape

11. Could this happen again in a future pregnancy?
    Recurrence risk is low, but your obstetric team may offer targeted ultrasounds given your history. Medscape

12. Are “immune boosters” or stem-cell treatments used?
    No—there are no approved immune or stem-cell drugs for jejunal atresia. Standard, proven care is surgery plus excellent neonatal nutrition and infection prevention. NCBI+1

13. Why are ERAS-Neonates pathways important?
    They combine best practices (pain control, nutrition, line care) to shorten recovery and reduce complications. PMC

14. How do teams prevent PN-related problems?
    Strict line care, thoughtful lipid selection, and regular labs for vitamins/trace elements are key to avoid infections and liver issues. ESPN

15. When should we seek help after going home?
    Any bilious vomiting, poor feeding, fever, wound redness, or fewer wet diapers needs urgent assessment. Medscape

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: September 25, 2025.

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