Gabrielle Zimbric 8/9/10, AM Report

Neonatal Feeding Intolerance

GERD, Pyloric stenosis, obstruction, sepsis, too high volume, increased ICP, IEM,
malrotation, UTI, failure (renal, heart, liver), NEC, gastroenteritis, intussuception,
dysmotility

•Abdominal distention/ tenderness

• increased or absent bowel sounds
• Emesis, residuals (higher volume,
bile/blood)
• Change in SOP, hematochezia
• A/B/D spells
 • Check tube position (esophagus? Kinked? )
Try right lateral decubitus position (helps empty)
Is further workup indicated?

What is an abnormal residual? > 2ml/kg/feed, > 50% of feed

volume, or significant change

Blood Bile

-inflammation -obstruction
(NEC?) -overdistended
-NG trauma stomach
-ulcer -reflux of bile
-swallowed maternal into stomach
blood?
 Turner’s
• RENAL (30-50%, UTI, HTN, horseshoe)
• HEART (2-10% COA, 20-30% aortic valve dx)
• BONES (osteoporosis)
• Malignancy (gonadoblastoma)
• ENDO (hypoTH, DM)
• GI (celiac in 6%)
• EYE
 Coarctation
• Difference in SBP between upper/lower (in
non-COA, legs >arms by 10-20)
• Delayed/absent femoral pulses
• Usually proximal to L Subclavian ( HTN in
both arms)
• CXR
– “3 sign”- aortic wall indentation w/ pre+post
dilation
– Rib notching (collateral arteries, age 4 y-12 yr)
 5 Points
1. Revise your differential diagnosis
2. Examine the patient (even if “cranky”
baby)
3. Don’t fall for the boy-who-cried-wolf
4. Wide differential for feeding issues, make
sure to think about badness
5. Nothing is ruled out forever