Vomiting in the Newborn Vomiting in the Newborn Not uncommon for some vomiting in 1st Not uncommon for some vomiting in 1st few hours and days after birth few hours and days after birth Overfeeding, poor burping Overfeeding, poor burping DDx: 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 Bilious vomiting is a medical emergency! emergency!
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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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Vomiting in the NewbornVomiting in the Newborn
Not uncommon for some vomiting in 1st Not uncommon for some vomiting in 1st few hours and days after birthfew hours and days after birth Overfeeding, poor burpingOverfeeding, poor burping
Bilious vomiting is a medical emergency!Bilious vomiting is a medical emergency!
Upper GI problems Upper GI problems vomitingvomiting
EsophagealEsophageal:: first feed, soon after feedfirst feed, soon after feed excessive droolingexcessive drooling if T-E fistula, risk of aspirationif T-E fistula, risk of aspiration
ConstipationConstipation > 90% pass meconium in first 24 h> 90% pass meconium in first 24 h
If ‘constipation’ is present from birth:If ‘constipation’ is present from birth: Consider causes of GI obstructionConsider causes of GI obstruction
If present after birth:If present after birth: Consider Hirschprungs, hypothyroidism, anal Consider Hirschprungs, hypothyroidism, anal
stenosisstenosis
NB:NB: Some breastfed babies normally stool only Some breastfed babies normally stool only
once every 5-7 daysonce every 5-7 days Premature infants often have delayed Premature infants often have delayed
meconium passagemeconium passage
JaundiceJaundice First 24 h or conjugated at ANY time = ALWAYS abNFirst 24 h or conjugated at ANY time = ALWAYS abN Etiology: Etiology: UnconjugatedUnconjugated
HypothyroidismHypothyroidism3. 3. Increased Enterohepatic CirculationIncreased Enterohepatic Circulation:: GI dysmotility or obstructionGI dysmotility or obstruction Breast feeding jaundiceBreast feeding jaundice
Later onset: Conjugated1. 1. Hepatocellular damageHepatocellular damage: : • ViralViral• BacterialBacterial• Metabolic: TPN, CF, tyrosinemia, otherMetabolic: TPN, CF, tyrosinemia, other
Jaundice - Work-UpJaundice - Work-Up History and physical examinationHistory and physical examination Bilirubin - total and directBilirubin - total and direct Blood type and Coomb’sBlood type and Coomb’s HemoglobinHemoglobin Reticulocyte countReticulocyte count SmearSmear Septic workupSeptic workup +/- Abdominal Ultrasound+/- Abdominal Ultrasound +/- Metabolic, Viral workup+/- Metabolic, Viral workup
Risk factors for kernicterusRisk factors for kernicterus
Feto-maternalFeto-maternal Feto-placentalFeto-placental Feto-fetalFeto-fetal Intracranial or extracranialIntracranial or extracranial Rupture of internal organsRupture of internal organs
HemolysisHemolysis PrematurityPrematurity
Treatment:Treatment: Transfuse if necessaryTransfuse if necessary
Definition:Definition: BS <2.6 prem and bottle fed termBS <2.6 prem and bottle fed term BS <2.0 breastfedBS <2.0 breastfed ** No clear safe cutoff for all** No clear safe cutoff for all
Pathophysiology:Pathophysiology: Lack of supplyLack of supply Lack of reserve (low glycogen): IUGRLack of reserve (low glycogen): IUGR Inability to use/produce: metabolicInability to use/produce: metabolic Increased utilization: sepsisIncreased utilization: sepsis Increased insulin productionIncreased insulin production
HypoglycemiaHypoglycemia
Treat by supplying glucose needs:Treat by supplying glucose needs: Term: supply minimum of 4-6 Term: supply minimum of 4-6
mg/kg/minmg/kg/min Preterm: supply minimum of 6-8 Preterm: supply minimum of 6-8
mg/kg/minmg/kg/min
Look for cause … if severe or persists Look for cause … if severe or persists beyond 48-72h of lifebeyond 48-72h of life ‘‘Critical Sample’ of blood and urineCritical Sample’ of blood and urine
Asphyxia 46%Infection 17%Intracranial hemorrhage 7%Intraventricular hemorrhage 6%Infarction 6%Hypoglycemia 5%Congenital anomaly of CNS 4%Inborn errors of metabolism 4%Subarachnoid hemorrhage 2%