Anemia of Prematurity - Portal Neonatal

Every effort is made intraoperatively to preserve bowel length. Some children with short bowel
syndrome manage to survive with the aid of parenteral nutrition. Bowel lengthening procedures,
creation of intraluminal valves, and manipulation of bowel recovery with nutritional and hormonal
treatments can help wean the patient with short gut syndrome from dependence on parenteral
nutrition. In patients with severe volvulus with infarction of the entire midgut or multiple intestinal
atresias, the child may clearly not have enough bowel length to survive. A difficult ethical decision
must be made at the time of operation whether to proceed with resection.
CONCLUSIONS Section 9 of 11
Bowel obstruction in the newborn can be a true surgical emergency. Urgent surgical consultation is
appropriate in most patients with neonatal bowel obstruction, and catastrophic causes of both proximal
and distal bowel obstruction must be excluded without delay. Prompt recognition and treatment of the
source of obstruction can prevent complications ranging from gangrene and septic peritonitis to
catastrophic bowel loss. Bilious vomiting in a newborn should trigger an immediate suspicion of
malrotation with midgut volvulus and initiate an immediate workup or even exploratory laparotomy.
The importance of radiographic imaging modalities, especially contrast studies and ultrasonography,
cannot be overemphasized. Quick recognition and expeditious treatment usually results in successful
resolution of neonatal bowel obstruction, with resultant favorable short- and long-term outcomes for
the patient.
PICTURES Section 10 of 11
Picture 1. Bowel obstruction in the newborn. Malrotation.
Picture 2. Bowel obstruction in the newborn. Malrotation with volvulus. Proximal small intestine
coiled around superior mesenteric vessels.
Picture 3. Bowel obstruction in the newborn. Duodenal atresia. Note double bubble and narrowing in
second portion of the duodenum.