Gastrointestinal Disorders in Newborns

Question 1

What underlying conditions predispose infants to meconium plug formation?

Answer 1

Small left colon syndrome, CF, hypothyroidism, rectal aganglionosis (hirshsprung disease), maternal drug use, maternal magnesium sulfate therapy for pre-E

Question 2

Meconium ileus with resulting obstruction should make you think of what autosomal recessive disorder?

Answer 2

Cystic fibrosis

Meconium lacks pancreatic enzymes and contains increased amounts of albumin, making it thick and viscid.

Question 3

What will a KUB show in an infant with meconium ileus-induced peritonitis?

Answer 3

intraabdominal calcifications

Question 4

How is meconium ileus usually treated?

Answer 4

Diatrizoate sodium enema

Question 5

Which infants are more likely to have NEC?

Answer 5

Mainly preterm infants

Question 6

What are the 2 pathognomic x-ray findings seen with NEC?

Answer 6

1. Pneumatosis intestinalis - gas accumulation in the submucosa of the bowel wall
2. Air in the haptic portal system

Question 7

Describe the immediate management of an infant with suspected NEC.

Answer 7

Bowel rest, NG decompression, aggressive fluid resuscitation, IV fluids @ 1.5x, correction of any metabolic/electrolyte derangement

Question 8

With what process do you predict which newborns are at risk for hyperbilirubiemia and will required repeated bilirubin checks?

Answer 8

Bilirubin nomogram

Question 9

When does the serum bilirubin peak occur in the healthy newborn?

Answer 9

Peaks 3-4 days of life

• Increased rate of bilirubin production
• Reduced rate of bilirubin elimination