7days neonate with abdominal distention, vomiting, constipation.

7days/M baby has not cry after birth.o2given. Now the baby has abdominal distention. Does not take feed.when parents feeds him BM by spoon he vomits yellowish like bile. Baby has not passed stool.pl sug DX RX.

1 Like

LikeAnswersShare

abdomen appears shiny n distended . plus history of bilious emesis n feed intolerance . early features of necrotising enterocolitis . plus history of perinatal asphyxia / nicu admission . all predisposes to it . readmit the patient keep naaogastric tube in situ iv antibiotics like inj piperacillin n inj mikacin inj metrogyl . iv fluids ionotrop support . keep npo . serum electrolytes . xray erect abdomen usg abdomen needs to b done . paediatric surgeon opinion .

Thank you doctor
0

Most likely cause is a functional constipation with faecal impaction. A Digital rectal examination is done - if hard stools are found - it is functional constipation and a plain X - ray abdomen standing can be helpful. Second most likely Diagnosis ia HITSCHSPRUNG DISEASE - which can be Diagnosed by rectal biopsy. Other D/ D is Congenital ano- rectal malformation Pseudo-obstructipn Congenital hypothyroidism Spinal cord abnormality

Thank you doctor
0

कुमार कल्याण रस स्वर्ण युक्त 1 रत्ती एक चम्मच शहद में मिलाकर दिन में तीन बार सेवन कराएं। निश्चित रूप से लाभ होगा। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।

You didnt mention gestation of baby. also, please reconfirm if the baby hasnt passed stools since birth ( ask history of meconium stained liquor, passing stool immediately post delivery)? or just last few days. Failure to pass stools, abdominal distension and bilious vomiting points towards Lower GI obstruction. Differential diagnosis includes Hirschprung disease, Anorectal malformations, Meconium Ileus, Intestinal perforation etc. A very important differential with common history like this is Malrotation and Volvulus, where baby may have passed stools sometime after birth. this can cause significant gut necrosis and warrants immediate surgical intervention. Do not take it lightly, if you are not sure of history, its better to investigate rather than false comfort. Investigations: blood gas and lactate, sepsis screen, xray abdomen AP and left lateral decubitus, Upper GI contrast, Ultrasound abdomen. treatment: 1. refer immediately to surgical centre. 2. Keep nil by mouth, put NG tube under free drainage for abdominal decompression 3. start IV fluids 10% Dextrose at around 150 ml/kg/day 4. Start antibiotics like Cefotaxime- Amikacin- Metronidazole Good luck.

There r many causes for this type of signs & symptoms, I have queries?? Whether Baby has passed Meconium in up to 48 hrs.of birth or not?? If not the causes are, 1.Insipiatted meconium ileus intestinal obstruction 2.Functional immaturity of colon 3.Hirshprungs disease 4.Anirectal malformation Other Important causes for abdominal distention INTESTINAL MALROTATION C MIDGUT VOLVOLUS, a SURGICAL EMERGENCY, 2.Intestinal atresia Bile is greenish, not yellow, First it has to be managed for Vitals, Fluid &Electr status, nasogastric tube, X-Rar of abd.....followed by Contrast study. Consult Ped.Surgeon for management

Rectal stimulation first, if no stool aganglionic megacolon, NEC , congenital ano rectal malformation - check the orifice, anal opening

Thank you doctor
0