Neonatal+Emesis+and+Abdominal+Distention

=**Important Concepts, Management Approach, and Materials -**=
 * Important Concepts -**
 * Babies spit up a lot, but bilious emesis is a very worrisome sign.
 * Bilious emesis is bright green (not yellow).
 * Swallowed blood in the stomach is irritating.
 * Maternal History: polyhydramnios? Abnormal ultrasound?
 * Did the baby have low Apgars?
 * Magnesium exposed babies have relaxed smooth muscle tone and are more likely to regurgitate and less likely to feed well.
 * Check the plumbing: any obstruction from mouth to anus can cause distension - the higher up, the quicker the symptoms.
 * Has the baby passed meconium?
 * Is this a premie?
 * NEC (necrotizing enterocolitis) is a very serious disease.


 * Management Approach -**
 * If it appears to be just a little spitting up and especially if there is swallowed maternal blood in stomach: consider gastric lavage (there is a protocol in the nursery). If needed: NPO, IV D10w at 80% maintenance, careful observation.
 * If emesis is persistent or if distension is significant: NPO, IV 80-100 ml/kg/day, KUB, Orogastric tube to low intermittent suction. If Xray is normal and symptoms resolve, you may re-try feedings 12-24 hrs later. Screen for sepsis (CBCD, BC, consider CRP).
 * If you check and notice an imperforate anus or the x-ray looks like obstruction: NPO, IV @ 100ml/kg/day, Orogastric tube to low suction, screen for sepsis, if baby sick looking with poor perfusion: treat for sepsis. Will need transfer for Pediatric Surgical evaluation at CHO.
 * If NEC is suspected, always be proactive, call the peds attending!


 * Necrotizing Enterocolitis Powerpoint Presentation** - [|Necrotizing Enterocolitis2010.ppt]


 * Abdominal Wall Defects Powerpoint Presentation** - [|Abdominal Wall Defects 2010.ppt]

Learning Objectives: 1) Assess a baby with feeding intolerance. 2) Discuss the differential of emesis, and know what red flags would cause you to refer to a higher level of care. 3) Describe the workup of a baby with no stool within 48 hours. 4) Describe how to initiate a work up of a baby with abdominal distention, emesis, or hematemesis.

Evaluation: 1) (yes/no) Resident has reviewed the above topics with an attending during the nursery rotation.

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