Neonatal GI

Question 1

Gastrointestinal assessment

Answer 1

Look, listen feel.

• maternal hx
• look for distention and scaphoid appearance
• bowel sounds present around 15-30m of life
• liver margin should be right lower rib
• umbilicious should be beige at birth

Question 2

AXR characteristics

Answer 2

Should appear homogenous as gas across all four sections, with “mosaic” appearance

• concerning if sections of bowel do not have any air, though the also shouldn’t be distended
• upper obstructions present with minimal bowel gas
• lower obstructions often present with copious bowel gas
• air-fluid levels

Question 3

Concerning features of neonatal vomit

Answer 3

• change in vomiting pattern
• blood or bilious vomit
• other concerning clinical features in addition to the vomiting

Question 4

What is bilious vomit

Answer 4

• green vomit, produced by obstruction just distal to the bile duct
• bile give the green colour, which would be mixed to a darker brown colour if the obstruction were further down the gut
• green means go to OR ASAP
• Volulus is the malrotation of the intestine. Bilious vomiting is a sign of volvulus and should be treated as volvulus until proven otherwise

Question 5

Common causes of neonatal GI bleeding

Answer 5

anal fissures
cows milk protein allergy
swallowed maternal blood (cracked nipples)

NEC is the most common cause of bloody stool in preterm infants

Question 6

Double bubble is a classic sign of

Answer 6

Duodenal atresia

Question 7

Duodenal atresia mgmt

Answer 7

NPO, IV nutrition, NG to suction

Question 8

Small bowel obstruction can present with

Answer 8

bilious emesis, within the first week of life. Usually generally well with feeding difficulties, so often irritable

Question 9

small bowel obstruction mgmt

Answer 9

NPO
IV nutrution
NG suction
Surgery for resection

Question 10

Meconium Ileus is

Answer 10

meconium is grossly thick and sticky, producing a small bowel obstruction that perforates before birth. the meconium in the peritoneum becomes calcified and presents as a density on AXR

Question 11

Hirschsprungs disease is

Answer 11

Distal bowel ileus. the lower section of the bowel that is lacking ganglion cells will never function accordingly, meaning it must be removed to allow for peristalsis through the entirely of the bowel

Question 12

Clinical presentation of Hirshsrpungs

Answer 12

may stool with rectal stimulation
delayed passage of meconium >24 hours. can present from birth to age 3.
associated with other chorosmal abnormalities

Question 13

Hirshsprungs diese dx

Answer 13

AXR showing lack of distal bowel air comparative to the proximal bowel, secondary to reducing peristalsis causing a degree of bowel obstruction

Question 14

Gastroschesis is

Answer 14

A defect in the anterior abdominal wall which allows peritoneal contents to protrude. Thought to be due to vascular disruption of blood supply to abdominal wall. Associated with maternal vasoactive drugs use and young maternal age

-presents to the right of umbilicus

Question 15

Gastroschisis complications

Answer 15

Infection
fluid and sodium loss
heat loss
feeding issues after repair

Question 16

Gastroschesis mgmt

Answer 16

• sterile wrap (no dry gauze)
• NPO NG to suction
• IVF with increased TFI for insensible losses
• Keep warm (plastic bag)
• Abx
• Place Baby on left side
• intubation rather than CPAP to prevent bowel distention
• silo placement with serial reduction, followed by surgical closure.

Question 17

When should neonates pass mex

Answer 17

within first 24 hours

Question 18

What is bilirubin

Answer 18

Bilirubin is the breakdown production of heme metabolism processed in the liver

Question 19

Physiologic heme is normal in term babies for what time frame

Answer 19

Day 3 - 7

Question 20

At extremely high levels, bilirubin can deposit in the basal ganglia and cause

Answer 20

Kernicterus

Question 21

treatments for hyperbilirubinemia

Answer 21

1. phototherapy
2. increase TFI by 20% due to insensible losses
3. Exchange transfusion
4. IVIG

Question 22

Hyperbilirubinemia definition

Answer 22

Unconjugated bili is a waste product of hemoglobin breakdown that is take up by the liver, where its converted into conjugated bilirubin

-conjugated bili is water-soluble and exerted into the bile to be cleared from the body

Question 23

Describe eBilirubin production

Answer 23

bilirubin is a product of heme catabolism.

approx 80-90% of bilirubin is produced during the breakdown of Hb

Question 24

why do we see it in neonates

Answer 24

neonates have more red cells which have a. shorter half life span than adults

Question 25

Whats BIND

Answer 25

bilirubin induced neurological dysfunction

• occurs when bili crosses the BBB and binds to brain tissue resulting in brain injury if not treated rapidly

Question 26

Whats being neonatal hyperbili

Answer 26

Is a transient and normal increase in bili level occurring in almost all newborns, - physiologic jaundice

Question 27

Most common life-threatening GI disorder in the preterm neonate

Answer 27

necrotizing Entercolitis

Question 28

Risk factors for NEC

Answer 28

Prematurity, LBW

• formula feeding
• conditions that reduced BF to the gut (cardiac conditions, birth aphaxia, medications, growrth restrictions)

Question 29

Pathogensis of NEC

Answer 29

Involves bowel wall injury and inflammation leading to:

• bacterial translocation into intestinal wall
• gas accumulation in submucosal layer
• necrosis
• perforation
• sepsis
• death

Question 30

NEC mgmt

Answer 30

-NPO - bowel rest 7-14days
-IVF
-Abx
-surgical consultation
-In transport
(intubation, fluid, inotropic, blood support)