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 birthOverfeeding, poor burpingDDx:GI: obstruction, reflux, milk allergy, NECInfection: Sepsis, Meningitis, UTIEndocrine: Adrenal hyperplasiaCNS: Increased ICPDrugsBilious vomiting is a medical emergency!
2 Upper GI problems vomiting Esophageal:first feed, soon after feedexcessive droolingif T-E fistula, risk of aspirationSmall bowel atresiasMalrotation and volvulusAchalasiaChalasia/GERPyloric stenosis} Need to r/o
6 Lower GI Obstruction Presents with: Extrinsic vs intrinsic obstruction DistentionFailure to pass meconiumVomiting is a later signExtrinsic vs intrinsic obstructionDDx: Imperforate anus, Hirschprung, meconium ileus, meconium plug, ileal atresia, colonic atresia
10 Constipation > 90% pass meconium in first 24 h If ‘constipation’ is present from birth:Consider causes of GI obstructionIf present after birth:Consider Hirschprungs, hypothyroidism, anal stenosisNB:Some breastfed babies normally stool only once every 5-7 daysPremature infants often have delayed meconium passage- Focus on the fact that
11 Jaundice First 24 h or conjugated at ANY time = ALWAYS abN Etiology: Unconjugated1. RBC destruction/hemolytic :Isoimmune, RBC membrane, enzymes, hgbinopathiesHematomaSepsis (mixed hemolytic and hepatocellular damage)Hypoxia2. Conjugation Abnormalities:Breast Milk JaundiceMetabolic/Genetic: Gilbert, Crigler-Najjar, Hypothyroidism3. Increased Enterohepatic Circulation:GI dysmotility or obstructionBreast feeding jaundiceJaundice, 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 BacterialMetabolic: TPN, CF, tyrosinemia, other2. Post hepatic:biliary atresiacholedochal cyst
13 Jaundice - Work-Up History and physical examination Bilirubin - total and directBlood type and Coomb’sHemoglobinReticulocyte countSmearSeptic workup+/- Abdominal Ultrasound+/- Metabolic, Viral workup
14 Risk factors for kernicterus PrematurityHemolysisAsphyxiaAcidosisInfectionCold stressHypoglycemia
15 Treatment of Jaundice Nutrition/hydration Phototherapy Exchange transfusion
16 Anemia Hemorrhage Feto-maternal Feto-placental Feto-fetal Intracranial or extracranialRupture of internal organsHemolysisPrematurityTreatment:Transfuse if necessary
17 Endocrine Issues - Hypothyroidism Screen because too late for proper neurodevelopment if waitSigns:Poor feedingConstipationProlonged jaundiceLarge fontanellesUmbilical herniaDry skin
23 Hypoglycemia Definition: Pathophysiology: BS <2.6 prem and bottle fed termBS <2.0 breastfed** No clear safe cutoff for allPathophysiology:Lack of supplyLack of reserve (low glycogen): IUGRInability to use/produce: metabolicIncreased utilization: sepsisIncreased insulin production
24 Hypoglycemia Treat by supplying glucose needs: Term: supply minimum of 4-6 mg/kg/minPreterm: supply minimum of 6-8 mg/kg/minLook for cause … if severe or persists beyond 48-72h of life‘Critical Sample’ of blood and urineEtiologies: Metabolic Disorder (Glycogen Storage Disease, Galactosemia), Endocrinologic (IDM, Hyperinsulinism)