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Neonatal vomiting
Neonatal vomiting
22
Bilious vomiting
No
Anatomic lesions
(proximal to ampulla of Vater)
Projectile
Yes
No
Nonanatomic lesions
GER/GERD
Inborn errors of metabolism
Congenital adrenal hyperplasia
Milk/soy allergy
Systemic infections
Neurological disorders
Child abuse
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Yes
Vomiting in the first few days after birth may be a sign of serious underlying pathology. Bilious emesis is suggestive of congenital obstructive GI malformations such as duodenal/jejunal
atresias, malrotation with midgut volvulus, meconium ileus or
plugs, NEC and HD. The etiology of intestinal obstruction is
identified in 3869% of neonates with bilious emesis. Any neonate with persistent bilious vomiting must have an NG or orogastric tube inserted to decompress the stomach and prevent
any additional vomiting or aspiration before initiating any diagnostic or therapeutic maneuvers. Plain radiographs of the abdomen can demonstrate dilated bowel loops and air-fluid levels,
which strongly suggest bowel obstruction. Contrast imaging
studies are more specific and can help pinpoint a precise diagnosis. Surgical consultation should be obtained urgently when
the diagnosis of bowel obstruction is considered.
There are a number of causes of nonbilious vomiting in the
young infant which should be considered. Acquired obstructive
lesions such as IHPS should be ruled out especially with a history of projectile vomiting. Infections including AGE and UTI
can present with vomiting. Vomiting can be prominent in the
presence of GER and food intolerance such as milk or soy protein allergies. Metabolic diseases and inborn errors of metabolism should also be considered in infants who have persistent
progressive vomiting. A basic laboratory screen that includes
CBC, urea, creatinine, electrolytes, glucose, blood gases, transaminases and a urine sample should be obtained in any infant
with persistent vomiting.
Selected reading
stenosis. A normal study does not rule out pyloric stenosis and
should be repeated if still suspected.
The following inborn errors of metabolism are associated
with vomiting:
Urea cycle defects
Congenital lysine intolerance
Familial (lysinuric) protein intolerance
Propionic academia
Methylmalonic academia
Isovaleric academia
Maple syrup urine disease
Phenylketonuria
Hereditary tyrosinemia
Hypervalinemia
Galactosemia
Hyperglycinemia
Leighs disease
Idiopathic hypercalcemia
Renal tubular acidosis
allergy is suspected.
Common neurological disorders leading to vomiting in
Neonatal vomiting
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