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Vomiting in the Newborn  Not uncommon for some vomiting in 1st few hours and days after birth Overfeeding, poor burping Overfeeding, poor burping  DDx:

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Presentation on theme: "Vomiting in the Newborn  Not uncommon for some vomiting in 1st few hours and days after birth Overfeeding, poor burping Overfeeding, poor burping  DDx:"— Presentation transcript:

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

2 Upper GI problems  vomiting  Esophageal: first feed, soon after feed first feed, soon after feed excessive drooling excessive drooling if T-E fistula, risk of aspiration 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: Distention Distention Failure to pass meconium Failure to pass meconium Vomiting is a later sign Vomiting is a later sign  Extrinsic vs intrinsic obstruction  DDx: Imperforate anus, Hirschprung, meconium ileus, meconium plug, ileal atresia, colonic atresia

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

11 Jaundice  First 24 h or conjugated at ANY time = ALWAYS abN  Etiology: Unconjugated 1. RBC destruction/hemolytic : Isoimmune, RBC membrane, enzymes, hgbinopathies Isoimmune, RBC membrane, enzymes, hgbinopathies Hematoma Hematoma Sepsis (mixed hemolytic and hepatocellular damage) Sepsis (mixed hemolytic and hepatocellular damage) Hypoxia Hypoxia 2. Conjugation Abnormalities: Breast Milk Jaundice Breast Milk Jaundice Metabolic/Genetic: Gilbert, Crigler-Najjar, Hypothyroidism Metabolic/Genetic: Gilbert, Crigler-Najjar, Hypothyroidism 3. Increased Enterohepatic Circulation: GI dysmotility or obstruction GI dysmotility or obstruction Breast feeding jaundice Breast feeding jaundice

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

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

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

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19 Endocrine Issues – Ambiguous Genitalia  Congenital adrenal hyperplasia 21-hydroxylase deficiency = most common enzyme abN 21-hydroxylase deficiency = most common enzyme abN Signs = vomiting, diarrhea, dehydration, shock, convulsions, clitoris or phallic enlargement Signs = vomiting, diarrhea, dehydration, shock, convulsions, clitoris or phallic enlargement Watch for electrolyte imbalances Watch for electrolyte imbalances If suspect, send lab tests and treat with steroids If suspect, send lab tests and treat with steroids

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

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

24 Hypoglycemia  Treat by supplying glucose needs: Term: supply minimum of 4-6 mg/kg/min Term: supply minimum of 4-6 mg/kg/min Preterm: supply minimum of 6-8 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 ‘Critical Sample’ of blood and urine

25 Neonatal seizures: Etiology

26 Thank you! Questions?


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