A newborns failure to pass meconium within 24 hours after birth may indicate which of the following
Introduction99% of healthy full-term infants pass their first stool or meconium within 24 hours of birth and all healthy term neonates should do so by 48 hours. Show
No neonate should be discharged before passing meconium, and failure of a full-term infant to pass meconium in the first day of life should raise suspicion of intestinal obstruction. Of note, up to a third of preterm infants will not pass meconium in the first 48 hours of life, and may take as long as 9 days for their first stooling. Neonatal intestinal obstruction occurs in 1/1500 live births. This will classically present as failure to pass meconium, progressive abdominal distention and anorexia, culminating in bilious emesis and/or intestinal perforation. Etiologies are from intrinsic developmental defects, abnormalities of peristalsis or intestinal contents, or from insults in utero after the formation of normal bowel. Failure to recognize and address neonatal bowel obstruction can result in aspiration of vomit, sepsis, mid-gut infarction, bowel perforation or enterocolitis. Differential diagnoses for presentations of intestinal obstruction in the neonate:Failure to pass meconium with bilious vomiting
Failure to pass meconium with non-bilious vomiting
Initial passage of meconium with subsequent obstruction and non-bilious emesis with each feed suggests pyloric stenosis Evaluation of Bilious EmesisBilious emesis in the neonate should be treated as a life-threatening emergency because it is often a presenting symptom of volvulus. Evaluation of clinically stable neonates begins with cessation of PO feeds, nasogastric tube decompression, IV fluids, and blood gasses to assess acid-base status If infant has signs of systemic decompensation (eg hematemesis, peritonitis, shock), patient should immediately be taken for emergent surgical exploration for assumed malrotation and volvulus Stabilized patients should have appropriate imaging. Most likely, patient will have abdominal plain film as first step, with a variety of possible etiologic clues
Meconium Plug Syndrome
Meconium ileus
Anorectal Malformation
Malrotation and volvulus
Duodenal atresia
Radiograph with double-bubble sign from duodenal atresia https://en.wikipedia.org/wiki/Duodenal_atresia
Pyloric Stenosis
Hirschsprung’s disease
Jejunoileal atresia
Necrotizing enterocolitis
Annular Pancreas
References1. Failure to pass meconium: diagnosing neonatal intestinal obstruction. Loening-Baucke V. Am Fam Physician. Nov 1999; 60(7): 2043-2050. 2. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Kimura K. Am Fam Physician. May 2000; 61(9): 2791-2798. 3. Imaging of neonatal gastrointestinal obstruction. Hernanz-Schulman M. Radiol Clin North Am. Nov 1999; 37(6):1163-1186. 4. Behrman: Nelson Textbook of Pediatrics, 16th ed (2002). Philadelphia: W.B. Saunders Company. 5. A decade of experience with the primary pull-through for Hirschsprung disease in the newborn period: a multicenter analysis of outcomes. Teitelbaum DH. Ann Surg. Sep 2000; 232(3):372-380. 6. Genetics of Hirschsprung's disease. Parisi MA. Curr Opin Pediatr. Dec 2000; 12(6):610-617. 7. Long-term outcome and quality of life after the Swenson procedure for Hirschsprung's disease. Bai Y, Chen H, Hao J, et al. J Pediatr Surg 2002; 37:639. 8.Ultrasonographic diagnosis criteria using scoring for hypertrophic pyloric stenosis. Ito S, Tamura K, Nagae I, et al. J Pediatr Surg 2000; 35:1714. 9. NEJM. A Newborn Boy with Vomiting, Diarrhea, and Abdominal distention. Jan 26, 2012 10. Pancreatic development and anatomical variation. Kozu T, Suda K, Toki F. Gastrointest Endosc Clin N Am 1995; 5:1. 11. Diagnostic Accuracy of Radiologic Scoring System for Evaluation of Suspicious Hirschsprung Disease in Children. Alehossein M, Roohi A, Pourgholami A. Iran J Radiol. 2015 April; 12(2): e12451. What happens if newborn doesn't pass meconium?The failure to pass meconium in the first 24 hours may be a sign of a medical condition such as an intestinal obstruction, and your pediatrician should be contacted. More commonly, babies pass their first meconium stool prior to birth resulting in meconium staining.
What causes delayed meconium?The time when the first meconium stool passes has been used as a marker for normal gastrointestinal functioning, and a delay can occur because of gestational immaturity, a severe illness, a bowel obstruction, or other cause. Delayed meconium passage can be a predisposing factor for bowel perforation.
Which of the following is the most common cause of delay in passage of meconium in the full term new born?In neonates, Hirschsprung disease is the most commonly considered among diseases that cause lower intestinal obstruction and delayed passage of meconium.
How soon after birth should a baby pass meconium?Meconium should be passed ideally within the first 24 hours and less frequently within the first 48 hours. There are a number of reasons why infants take longer to have their first poop, but if it is longer than 48 hours, they may need further evaluation. Stools should generally be a version of yellow, green, or brown.
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