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Vomiting in the Newborn

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Presentation on theme: "Vomiting in the Newborn"— Presentation transcript:

1 Vomiting in the Newborn
Not uncommon for some vomiting in 1st few hours and days after birth Overfeeding, poor burping DDx: GI: obstruction, reflux, milk allergy, NEC Infection: Sepsis, Meningitis, UTI Endocrine: Adrenal hyperplasia CNS: Increased ICP Drugs Bilious vomiting is a medical emergency!

2 Upper GI problems  vomiting
Esophageal: first feed, soon after feed excessive drooling if T-E fistula, risk of aspiration Small bowel atresias Malrotation and volvulus Achalasia Chalasia/GER Pyloric stenosis } Need to r/o

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6 Lower GI Obstruction Presents with: Extrinsic vs intrinsic obstruction
Distention Failure to pass meconium Vomiting is a later sign Extrinsic vs intrinsic obstruction DDx: Imperforate anus, Hirschprung, meconium ileus, meconium plug, ileal atresia, colonic atresia

7 Colonic atresia

8 Hirshsprung

9 Distal ileal volvulus

10 Constipation > 90% pass meconium in first 24 h
If ‘constipation’ is present from birth: Consider causes of GI obstruction If present after birth: Consider Hirschprungs, hypothyroidism, anal stenosis NB: Some breastfed babies normally stool only once every 5-7 days Premature infants often have delayed meconium passage - Focus on the fact that

11 Jaundice First 24 h or conjugated at ANY time = ALWAYS abN
Etiology: Unconjugated 1. RBC destruction/hemolytic : Isoimmune, RBC membrane, enzymes, hgbinopathies Hematoma Sepsis (mixed hemolytic and hepatocellular damage) Hypoxia 2. Conjugation Abnormalities: Breast Milk Jaundice Metabolic/Genetic: Gilbert, Crigler-Najjar, Hypothyroidism 3. Increased Enterohepatic Circulation: GI dysmotility or obstruction Breast feeding jaundice Jaundice, usually mild unconjugated bilirubinemia, affects nearly all newborns. Up to 65% of full-term neonates have jaundice at hours of age. Although some causes are ominous, the majority are transient and without consequences.

12 Jaundice Later onset: Conjugated 1. Hepatocellular damage: Viral
Bacterial Metabolic: TPN, CF, tyrosinemia, other 2. Post hepatic: biliary atresia choledochal cyst

13 Jaundice - Work-Up History and physical examination
Bilirubin - total and direct Blood type and Coomb’s Hemoglobin Reticulocyte count Smear Septic workup +/- Abdominal Ultrasound +/- Metabolic, Viral workup

14 Risk factors for kernicterus
Prematurity Hemolysis Asphyxia Acidosis Infection Cold stress Hypoglycemia

15 Treatment of Jaundice Nutrition/hydration Phototherapy
Exchange transfusion

16 Anemia Hemorrhage Feto-maternal Feto-placental Feto-fetal
Intracranial or extracranial Rupture of internal organs Hemolysis Prematurity Treatment: Transfuse if necessary

17 Endocrine Issues - Hypothyroidism
Screen because too late for proper neurodevelopment if wait Signs: Poor feeding Constipation Prolonged jaundice Large fontanelles Umbilical hernia Dry skin

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19 Endocrine Issues – Ambiguous Genitalia
Congenital adrenal hyperplasia 21-hydroxylase deficiency = most common enzyme abN Signs = vomiting, diarrhea, dehydration, shock, convulsions, clitoris or phallic enlargement Watch for electrolyte imbalances If suspect, send lab tests and treat with steroids don’t label the baby’s sex if uncertain Hx, P/E, Abdominal U/S, glucose, lytes, 17-OH Progesterone level, cortisol, other endocrinological tests, CONSULT and TRANSFER!

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21 Endocrine Issues – Infant of a Mom with Diabetes
Increased Risk of: Congenital malformations Increased incidence with poor glycemic control Growth disturbances Metabolic disturbances Hypoglycemia, hypocalcemia Respiratory: RDS, TTN Hematologic: Polycythemia  Hyperbilirubinemia Cardiovascular problems: Hypertrophic cardiomyopathy

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23 Hypoglycemia Definition: Pathophysiology:
BS <2.6 prem and bottle fed term BS <2.0 breastfed ** No clear safe cutoff for all Pathophysiology: Lack of supply Lack of reserve (low glycogen): IUGR Inability to use/produce: metabolic Increased utilization: sepsis Increased insulin production

24 Hypoglycemia Treat by supplying glucose needs:
Term: supply minimum of 4-6 mg/kg/min Preterm: supply minimum of 6-8 mg/kg/min Look for cause … if severe or persists beyond 48-72h of life ‘Critical Sample’ of blood and urine Etiologies: Metabolic Disorder (Glycogen Storage Disease, Galactosemia), Endocrinologic (IDM, Hyperinsulinism)

25 Neonatal seizures: Etiology

26 Thank you! Questions?


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