Most neonatal GI malformations develop after birth, with vomiting, abdominal distension, defecation dysfunction, i.e., dyspnea as the main symptoms, similar to some pediatric diseases such as dyspepsia and pneumonia, which can easily delay the diagnosis. For this reason, not only pediatric surgeons, but also pediatricians and obstetricians must understand the clinical features of this disease to achieve early diagnosis and timely treatment in order to reduce the death rate of neonatal gastrointestinal malformations. I. Diseases with respiratory distress, choking and cyanosis as the main clinical manifestations 1, congenital esophageal atresia: mostly type III, that is, the proximal end of the esophagus is blind, and accompanied by esophageal tracheal fistula, is a representative surgical disease requiring urgent treatment in the neonatal period. In the past, the mortality rate was quite high, but with the development of perinatal medicine and neonatal surgery, the mortality rate has been decreasing year by year, and has dropped to less than 10% abroad, and the cure rate in China is about 70-90%. The key to success lies in early diagnosis, as the disease has a history of excessive amniotic fluid or postnatal asphyxia, postnatal aspiration pneumonia, the severity of pneumonia is an important factor affecting the prognosis. If the newborn is born with foamy mouth, drooling, choking, shortness of breath, cyanosis and dyspnea after feeding or sucking milk, and the symptoms improve after aspiration of secretions in the mouth, the possibility of this disease should be thought of, and then the nasal feeding tube can be tried, and if the catheter is obstructed or folded back from the mouth, the catheter can be adjusted to the blind end, and the diagnosis can be confirmed by taking a chest X-ray and injecting iodine oil through the catheter for imaging. After the diagnosis is confirmed, preoperative preparation should be actively done and a phase I anastomosis should be performed. 2. Thoracoabdominal hiatal hernia: This disease is caused by a huge defect in the diaphragm and the entry of abdominal organs into the thoracic cavity, accompanied by pulmonary dysplasia and pulmonary hypertension, so that death is caused by respiratory distress and hypoxemia soon after birth. In recent years, the rate of death has been significantly reduced after the adoption of artificial membrane lung (EcMI) abroad. In mild cases, shortness of breath or mild cyanosis occurs during breastfeeding or crying, but the symptoms are relieved when the chest is elevated or in lateral position, and are easily combined with pneumonia. The lungs are atrophied and the mediastinum is ectopic to the healthy side. Barium meal fluoroscopy can confirm the diagnosis by finding that the stomach and intestinal tube have entered the thoracic cavity. 3. Esophageal hiatal hernia: This disease develops when the stomach partially or completely enters the thoracic cavity through an enlarged esophageal hiatal hernia. Most of the children spill milk or vomit milk after feeding, or vomit brown or coffee-colored material in severe cases. The diagnosis is mainly made on the basis of X-ray film, and a gastric vesicle is seen in the chest cavity on chest film, and further barium meal fluoroscopy can confirm the diagnosis. In severe cases, hernia repair and esophageal hiatal hernia repair should be performed in time. In mild cases, conservative treatment can be performed first, and then surgical treatment can be performed if no improvement is seen. The main clinical manifestations are abdominal distension, vomiting, dyspnea and cyanosis. 1. Neonatal gastric perforation: the etiology is unclear and may be related to high gastric acid, increased intragastric pressure and congenital gastric wall development defects in newborns. The perforation is mostly located on the anterior side of the greater curvature of the stomach. The onset of the disease is mostly within 2 to 3 days after birth, with a highly distended abdomen, varicose veins in the abdominal wall, restricted abdominal breathing, edema and redness of the abdominal wall, disappearance of the pulmonary and hepatic boundaries, and diminished or absent bowel sounds. The symptoms deteriorate rapidly due to vomiting, dyspnea and cyanosis caused by abdominal distension, and toxic shock occurs within 1 to 2 days after the disease, with a mortality rate of more than 50%. Abdominal puncture can extract a large amount of gas and gastric contents, X-ray fluoroscopy can be seen under the diaphragm free gas, after the diagnosis should be prompt emergency surgery. 2, fetal fecal peritonitis: fetal fecal peritonitis refers to chemical sterile peritonitis caused by intestinal perforation in the embryonic period, fetal feces into the abdominal cavity, the formation of extensive adhesions around the intestinal tube, according to the early and late closure of the intestinal tube into peritonitis type and intestinal obstruction type two. If the perforation is not closed after birth, the signs and symptoms of typical neonatal peritonitis appear 1 to 2 days after birth, and the diagnosis is confirmed by the presence of characteristic calcified spots on x-ray. The disease can be diagnosed prenatally if the calcified shadows are detected in the fetal period by x-ray or ultrasound examination. Treatment should be based on the type of pathology. The peritonitis type should be operated urgently by perforation suture or abdominal drainage, while the intestinal obstruction type can be treated conservatively or surgically. Third, frequent vomiting and vomit with milk (without bile) as the main symptoms of the disease Congenital hypertrophic pyloric stenosis occupies the third place of digestive tract malformations. The disease mostly develops 2-3 weeks after birth, the main manifestation of the disease is vomiting after eating, vomiting after a strong sense of food, vomit for milk without bile, vomiting in the form of jets. Malnutrition, lethargy, significantly reduced stool and urine output, and no weight gain are the clinical manifestations. The patient’s upper abdomen is seen to have gastric pattern and peristaltic waves, and a fusiform cartilage-like mass can be found at the outer edge of the rectus abdominis muscle in the right upper abdomen. barium X-ray reveals a pyloric duct >1 cm in length and a curved pressure mark in the pyloric sinus. After diagnosis, pyloromyotomy should be performed. After surgery, the symptoms improve and the long-term results are satisfactory. Fourth, vomiting, abdominal distension, defecation difficulties as the main symptoms of the disease 1, high intestinal obstruction: the onset of the child 3-5 days after birth, the first symptom is vomiting, the vomit is yellow-green bile-like contents, there may be a little meconium discharge, the upper abdomen can be seen inflated and intestinal type, the lower abdomen is flat, X-ray film shows double bubble or three bubble sign, the lower abdomen intestinal cavity inflatable less. If the above typical clinical manifestations are present, it is a duodenal or upper jejunal obstruction. There are three common causes, namely: A, congenital duodenal and jejunal atresia and stenosis; B, congenital intestinal malrotation; C, cricothyroid pancreas. The clinical manifestations of the above three gastrointestinal malformations are similar. Barium enema should be performed to observe the location of ileus, and congenital intestinal malrotation should be considered if the ileus is in the right upper abdomen. After diagnosis, surgery should be performed. 2, low intestinal obstruction: If abdominal distension, vomiting and no fetal stool are present after birth, the following four diseases should be thought of, namely congenital anorectal malformation, congenital megacolon, congenital anorectal malformation, congenital megacolon, congenital colonic atresia and fetal fecal constipation. ①, congenital anorectal malformation: this disease accounts for the first place of gastrointestinal malformation, its lesion and pathological typing is complex, not only the anal atresia, but also the developmental defects of the internal and external anal sphincter, sacral vertebral malformation and urinary tract malformation. According to the location of the blind end of the rectum is divided into high, medium, low three types, and there is a combination of rectourethral fistula, rectovaginal fistula, such as improper surgical treatment, will cause defecation, incontinence and other serious defecation dysfunction, and even affect the quality of life, so early diagnosis, appropriate surgical treatment at the right time is appropriate. ②, congenital megacolon: congenital megacolon accounts for the second digestive tract malformation, about 1/3 of the children in the neonatal period (i.e., within 1-6 days after birth) acute intestinal obstruction, clinical manifestations of constipation, 24-48 hours after birth still no fetal feces or only a small amount of fetal feces discharge, must be enema or anal finger diagnosis before more fetal feces discharge, followed by relief of abdominal distension, but a few days later, persistent constipation. Neonatal congenital megacolon, if not treated in time, can often lead to serious complications, such as small bowel colitis, colonic perforation, megacolon crisis, etc. The morbidity and mortality rate is quite high, after diagnosis, non-surgical treatment should be performed first, and if it is not effective, megacolon resection will be performed after 2 months. ③, the differential diagnosis of neonatal low intestinal obstruction: A, check whether the child has anus, the location of the external anal opening, the size of the combined fistula, etc.; B, anal examination should be listed as a routine, if there is no anus is an anorectal malformation, if there is an anus should be immediately anal examination, anal examination should pay attention to the presence of fetal stool discharge, if there is no normal fetal stool, only a little grayish white mass or mucus should be considered as congenital intestinal atresia. If there is a large amount of fetal stool, it should be considered as fecal constipation or congenital megacolon. Meconium constipation improves after bowel cleansing and does not recur, while congenital megacolon can recur with abdominal distention and constipation.