DIGESTIVE SYSTEM

VOMITING

may be due to irritation of the gastric

mucosa by material swallowed during
delivery
A frequent symptom in neonates
Persistent:
! consider intestinal obstruction, metabolic
disorders and Increased ICP
VOMITING
Bile stained emesis
! suggests obstruction beyond the duodenum
! Xray of the abdomen
!Detects air fluid levels, distended bowel loops,
double bubble sign, pneumoperitoneum
VOMITING
Esophageal obstruction
• vomiting occurs with the first feeding
Intestinal obstruction
• bile stained
• non projectile
• begins on the 1st day of life
! Air in abdominal xray:
◦ Jejunum - 15 to 60 mins
◦ ileum - 2-3 hrs
◦ Colon - 3 hrs after birth
◦ Absence of rectal gas at 24 hrs is
abnormal
! Vomiting with obstipation
◦Common early sign of Hirschsprung dse
CONSTIPATION
◦ 90% of full term newborn pass
meconium in 24 hours
◦ Consider
! intestinal atresia
! aganglionic megacolon
! meconium ileus
! meconium plug
! congenital hypothyroidism
CONSTIPATION
◦ 20% of VLBW not pass meconium within
1st 24 hrs
Meconium Plugs
! Assoc. with
◦ IDM
◦ Rectal aganglionosis
◦ Maternal opiate use
◦ Magnesium sulfate therapy with
preeclampsia
! Evacuated by glycerin suppository or
rectal irrigation with normal saline
MECONIUM ILEUS
! Assoc w/ cystic fibrosis
transmembrane regulator mutations
! Absence of fetal pancreatic
enzymes
! Most concentrated in the lower
ileum
! Presents with signs of obstruction
MECONIUM ILEUS
! Presumptive Dx
◦ Hx of CF in a sibling
◦ Palpation of doughy or cordlike masses
of intestines thru the abdominal wall
MECONIUM PERITONITIS
! Perforation of intestines in utero or
shortly after birth
! Usually a complication of
◦ meconium ileus in CF
◦ meconium plugs
MECONIUM PERITONITIS
! calcifications on xray
! Clinical findings
◦ abdominal distention
◦ Vomiting
◦ absence of stools
MECONIUM PERITONITIS
! Treatment
◦ elimination of obstruction and peritoneal
drainage
Necrotizing Enterocolitis (NEC)
! Most common life threatening GI
emergency of the neonatal period
! Characterized by various degrees of
mucosal or transmural necrosis of the
intestine
! MC: distal part of the ileum and
proximal segment of the colon
Necrotizing Enterocolitis
! Multifactorial cause
! Risk Factors:
◦ Intestinal immaturity
◦ Ischemia or injury
◦ Inflammation
◦ Intake
NEC
! Assoc with intestinal immaturity
! Triad
◦ Intestinal ischemia (injury)
◦ Enteral nutrition
◦ Bacterial translocation
! Prematurity:
greatest risk factor
! Less common in breastfed infants
Necrotizing Enterocolitis
! Clinical manifestations
◦ Onset: 2nd or 3rd week of life
◦ Non specific:
! lethargy
! temp instability
! abdominal distention
! gastric retention
! bloody stools: 25% of cases
Necrotizing Enterocolitis
! Diagnosis
◦ High index of suspicion
◦ Abdominal xray
◦ Bell’s Staging
Necrotizing Enterocolitis
Portal venous gas(pneumatosis
intestinalis)
Necrotizing Enterocolitis
! Treatment
◦ Antibiotics
◦ NPO
◦ TPN
◦ Decompression
◦ IV Fluids
◦ Surgical referral
Necrotizing Enterocolitis
! Prognosis
◦ Medical management fails in 20 – 40% of
confirmed NEC
◦ 10-30% die
◦ Later complications
! adhesions,
! short bowel syndrome
Necrotizing Enterocolitis
! Prevention
◦ Decrease incidence
! Exclusively breastfed
! Minimal enteral feeds followed by judicious
volume advancement
! Use of probiotics