Growth
Many babies with VACTERL are born small and have difficulty with gaining weight. Babies with VACTERL association, however, do tend to have normal development and normal intelligence. Pathology
Patients with abnormal cardiac and kidney function may be more at risk for hemolytic uremic syndrome

Diagnosis
Differential diagnosis
Baller–Gerold syndrome
CHARGE syndrome
Currarino syndrome
DiGeorge syndrome
Fanconi anemia
Feingold syndrome
Fryns syndrome
MURCS association
Oculo-auriculo-vertebral syndrome
Opitz G/BBB syndrome
Holt–Oram syndrome
Pallister–Hall syndrome
Townes–Brocks syndrome
VACTERL with hydrocephalus

Management
Epidemiology
The incidence of VACTERL association is estimated to be approximately 1 in 10,000 to 1 in 40,000 live-born infants. It is seen more frequently in infants born to diabetic mothers. While most cases are sporadic, there are clearly families who present with multiple involved members. History
The acronym VATER association was first described by Linda Quan, an emergency room physician, and David Smith, a man who was considered the father of dysmorphology in 1972, to define a non-random co-occurrence of the listed defects. Years later, research revealed that cardiac and renal abnormalities were common in the association, and the acronym was changed to VACTERL. However, no single cause was identified that links all these conditions together. Therefore, this VACTERL is termed as "association" instead of a "syndrome". The differentiation of the acronyms VACTERL and VATER is due to the variation in defects determined at or prior to birth. VACTERL contains vertebral, anal, cardiac, trachea-esophageal, renal/kidney, and limb defects where as VATER only has vertebral, anal, trachea-esophogeal, and renal defects. The "R" in VATER represented radial dysplasia. Though the differences are clear, the physical defects vary from case to case.
Telmisartan/amlodipine, sold under the brand name Twynsta among others, is a medication used to treat high blood pressure. It is a combination of telmisartan an angiotensin II receptor antagonist with amlodipine a calcium channel blocker. It is taken by mouth.Common side effects include dizziness, swelling, and back pain. Severe side effects may include low blood pressure, kidney problems, electrolyte problems, and a heart attack. Use during pregnancy may harm the baby. Telmisartan works by blocking the effects of angiotensin II while amlodipine works by decreasing calcium ion entry into smooth muscle and heart muscle.The combination was approved for medical use in the United States in 2009. The combination is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. References
External links
"Amlodipine besylate mixture with telmisartan". Drug Information Portal. U.S. National Library of Medicine.