Anemia of Prematurity - Portal Neonatal

Bowel Obstruction in the Newborn
Last Updated: June 15, 2004
Synonyms and related keywords: gastrointestinal surgical emergencies of the newborn, newborn
bowel obstruction, neonatal bowel obstruct
ion, bilious vomiting, proximal bowel obstruction, distal
bowel obstruction, newborn constipation, neonatal constipation, constipation in the newborn,
neonatal intestinal obstruction, meconium ileus, meconium plug syndrome, abdominal distention,
ileus, chronic neonatal ileus, functional bowel obstruction, polycystic kidney disease, malrotation,
volvulus, midgut volvulus, duodenal atresia, duodenal web, duodenal obstruction, jejunoileal
atresia, esophageal atresia, tracheoesophageal fistula, hypertrophic pyloric stenosis, Hirschsprung
disease, AUTHOR Hirschsprung's INFORMATION disease, congenital megacolon, colonic atresia, imperforate Section anus 1 of 11
Author: William Adamson, MD, Assistant Professor, Departments of Surgery and Pediatrics,
Division of Pediatric Surgery, Medical University of South Carolina
Coauthor(s): Andre Hebra, MD, Clinical Associate Professor, Department of Surgery, University of
South Florida School of Medicine; Director, Minimally Invasive Pediatric Surgery Program, Chief of
Surgery, All Children's Hospital
William Adamson, MD, is a member of the following medical societies: South Carolina Medical
Association
Editor(s): Shelley C Springer, MD, MBA, MSc, Neonatologist, Assistant Professor of Pediatrics,
Department of Pediatrics, University of Wisconsin, Madison; Robert Konop, PharmD, Director,
Clinical Account Management, Ancillary Care Management; David A Clark, MD, Chairman,
Professor, Department of Pediatrics, Albany Medical College; Carol L Wagner, MD, Associate
Professor, Department of Pediatrics, Division of Neonatology, Medical University of South Carolina;
and Neil N Finer, MD, Director, Division of Neonatology, Professor, Department of Pediatrics,
University of California at San Diego
INTRODUCTION Section 2 of 11
Bowel obstruction in the newborn is one of the most common and potentially dire newborn surgical
emergencies. Successful management of a newborn with a bowel obstruction depends upon both
timely diagnosis and prompt therapy. Many causes of bowel obstruction in the newborn can be
readily diagnosed with physical examination and simple radiographic examinations. Crucial to the
management of most newborn bowel emergencies is effective nasogastric or orogastric
decompression.
Early consideration of the need for surgical intervention may mean the difference between intestinal
salvage and catastrophe. Have a high index of suspicion; often, a surgeon's approach to a newborn
with a potential bowel obstruction is to rule out the worst possibility first. Important signs to identify
are stools containing occult blood, hypotension, metabolic acidosis, progressive respiratory failure,
and thrombocytopenia.
A delay in diagnosis of a newborn bowel obstruction may exacerbate the compromise of dilated
bowel upstream of the obstruction; result in clinical deterioration with dehydration, fever, and
unconjugated hyperbilirubinemia; and predispose the child to complications such as aspiration
pneumonia.
For example, a child with bilious emesis must be considered to have malrotation with volvulus until
proven otherwise. A few hours may make the difference between full recovery and massive bowel
necrosis. If a newborn in distress demonstrates evidence of a high-grade proximal small-bowel
obstruction with some air past the duodenum, suspect volvulus and urgently consider an exploratory
laparotomy.