VOMITING IN THE NEWBORN

congenital anomalies are a frequent cause, e.g. atresia, Hirshprungís Differential diagnosis: gastroenteritis gastroesophageal r...

• congenital anomalies are a frequent cause,
• e.g. atresia, Hirshprungís

Differential diagnosis:

1. gastroenteritis
2. gastroesophageal reflux
3. overfeeding
4. food allergy
5. milk protein intolerance

Tracheoesophageal Fistula  (TEF)

• incidence: 1:3000-1:4000

clinical features (vary with type)

1. vomiting
2. coughing and gagging
3. cyanosis with feeds
4. respiratory distress
5. may have history of maternal polyhydramnios
6. associated anomalies: VATER 
• Vertebral anomalies,
• Analatresia,
• TEF and
• Renal disease plus cardiac abnormalities and Radial defects of the upper limb

x-ray : plain and contrast studies show anatomic abnormality,NG tube curled in pouch

Treatment: early repair to prevent lung damage and maintain nutrition

complications

1. pneumonia, lung damage, chronic reactive airways
2. stenosis and strictures at repair site
3. gastroesophageal reflux and poor swallowing following repair

Duodenal Atresia

Clinical features

1. bile-stained vomiting if distal to bile duct
2. abdominal distention, peristaltic waves
3. dehydration
4. associated with Down syndrome
5. may have history of maternal polyhydramnios

Abdominal x-ray

1. air-fluid levels on upright film
2. "double bubble" sign (dilated stomach and duodenum)

Differential diagnosis:

1. annular pancreas
2. aberrant mesenteric vessels
3. pyloric stenosis

Treatment

1. decompression with NG tube
2. correction of metabolic abnormalities
3. surgical correction

Pyloric Stenosis

1. most common in first-born males
2. often family history
3. M:F = 5:1

Clinical features

1. non-bilious projectile vomiting that occurs after feeding
2. usually starts at 2-6 weeks of age
3. infant hungry and alert, will re-feed FTT, wasting
4. dehydration, may lead to prolonged jaundice
5. gastric peristalsis goes from LUQ ------> epigastrium
6. “olive sign” (olive-shaped mass on right at margin of rectus
   abdominis muscle)

lab: hypochloremic metabolic alkalosis

diagnosis: clinical, abdominal ultrasound

treatment: pyloromyotomy


Malrotation of the Intestine

3 presentations:

1. recurrent vomiting (bilious intermittently)
2. FTT with vomiting
3. sudden onset abdominal pain and then shock

• if vomiting with bilious material, malrotation with volvulus until proven otherwise
• 80% experience symptoms in first two months of life

clinical features

1. distended abdomen
2. vomiting due to volvulus and bands across duodenum
3. cecum free

Diagnosed by upper

Gl studies: duodenum not fixed,spiral jejenum, mobile cecum (may not be in RLQ)

treatment: surgical

Other : meconium ileus (see Cystic Fibrosis Section)