Neonatal Intestinal Obstruction

Neonatal Intestinal Obstruction

1. Clinical Signs:

• No meconium passage, abdominal distension

• Bloody stools

• Vomiting

• Respiratory distress

2. Physiological Characteristics of the Neonatal Gastrointestinal Tract:

• Meconium should be passed within 6 hours of birth.

• Meconium is formed by ingested milk and bile.

• Meconium is dark green in color.

• If meconium is not passed within 24 hours, it is considered delayed meconium passage.

3. Causes of Neonatal Intestinal Obstruction:

• Membranous obstruction within the intestines

• Ladd’s bands

• Meconium plug

• Postoperative adhesions

4. Neonatal Intestinal Obstruction is:

• A surgical emergency.

• A condition involving intestinal blockage in infants under 1 year old.

• A condition that can be diagnosed early in the fetal period.

• Caused by various factors, often accompanied by other birth defects; without surgical intervention, the infant will die.

5. Abdominal Radiography in Neonatal Intestinal Obstruction:

• The shape and location of the air-fluid level can help diagnose the location and severity of the bowel obstruction.

• Two air-fluid levels located on either side of the spine are typical of ileal obstruction.

• A double-bubble image on prenatal ultrasound is suggestive of duodenal obstruction.

• Gastrointestinal contrast studies are not helpful in diagnosing the presence and location of obstruction.

• Barium enema is valuable in diagnosing congenital megacolon.

6. In Duodenal Obstruction:

• Annular pancreas is an internal cause of duodenal obstruction.

• Obstruction above the ampulla of Vater results in clear vomitus.

• Ladd’s bands form due to abnormal intestinal rotation.

7. Preparing Neonatal Patients for Surgery for Intestinal Obstruction:

• Keep the patient warm and maintain a stable body temperature using an incubator.

• Insert a nasogastric tube and aspirate periodically to prevent reflux into the lungs.

• Provide fluid and electrolyte replacement and broad-spectrum antibiotics.

8. During Surgery for Duodenal Obstruction Due to Ladd’s Bands:

• Sever Ladd’s bands.

• Perform an appendectomy (prophylactic, as the appendix is mislocated in the epigastric region).

• Widen the common mesentery.

• Move the colon to the right side and the small bowel to the left side.

9. Postoperative Care for Neonatal Intestinal Obstruction:

• Leave the nasogastric tube in place until the drainage is clear and the volume is minimal.

• Start feeding 3 days after surgery.

• Provide fluid and electrolyte replacement based on the infant’s weight.

• Monitor pulse, temperature, respiratory rate, weight, nasogastric drainage, and urine output.

• Administer intravenous fluids immediately after surgery; start oral feeding once gastric drainage is clear or the infant has passed meconium.

10. Postoperative Complications of Neonatal Intestinal Obstruction:

• Anastomotic stricture is a complication requiring immediate reoperation.

• Peritonitis due to anastomotic leak is a complication requiring immediate reoperation.

• Severe pneumonia due to reflux is a serious complication that can lead to death.

• Malabsorption due to short bowel syndrome occurs when only 1-2 meters of small bowel remain.

11. Factors That Predict a Poor Prognosis in Neonatal Intestinal Obstruction:

• Birth weight between 2500-3000g.

• Associated birth defects such as Down syndrome and heart defects.

• Resection of bowel with less than 40 cm remaining.

• Postoperative complications.

12. Multiple-Choice Questions:

• How long after birth is meconium passage considered delayed? C. 24 hours

• Which of the following clinical manifestations suggests neonatal intestinal obstruction? D. Absence of meconium on rectal examination

• Which of the following imaging studies is most practical in diagnosing neonatal intestinal obstruction? A. Plain abdominal radiography

• Which of the following images on plain abdominal radiography is characteristic of intestinal atresia? A. Typical air-fluid levels in the small bowel

• Which of the following images on plain abdominal radiography is typical of duodenal obstruction? D. Air-fluid levels located on either side of the spine

• What is the functional cause of neonatal intestinal obstruction? D. Congenital megacolon

• Which of the following conditions requires a gastrointestinal contrast study? C. Duodenal stenosis

• What is the plain abdominal radiography image for fetal peritonitis? C. Opaque abdomen with calcification

• Neonatal intestinal obstruction occurs in infants younger than? C. 1 month old

• What is the characteristic of vomiting in duodenal obstruction above the ampulla of Vater? B. Vomiting clear fluid.

• Which form of intestinal atresia has the worst prognosis? D. Atresia of multiple segments of the small bowel

• In which of the following situations is a bowel resection necessary? B. Atresia of a segment of the small bowel

• A 4-day-old male infant, born vaginally at term with a birth weight of 3100g. The infant passed meconium once after birth and has vomited bile-stained fluid. Examination revealed abdominal distension, and the anus is normal.

• What should you do for the infant? C. Provide fluid and electrolyte replacement, antibiotics, nasogastric tube, and rectal enema.

• What is the first imaging study needed to diagnose the condition? D. Plain abdominal radiography.

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