The diagnosis of a surgical condition in neonates with bilious vomiting was significantly associated with abdominal distension. Another potential contributor to abdominal distention is the initial retention of meconium or lack of stooling after passage of meconium. Pdf a preterm infant with mild abdominal distension and. He was referred to the emergency department in which an abdominal radiograph revealed gaseous distention of the bowel with a paucity of gas in the pelvis. A 2 day old full term boy was referred to our hospital with respiratory distress and abdominal distension. Topics include masses, bowel distention, functional disorders, ischemia and intestinal obstruction. A fullterm male was born after a pregnancy complicated between 22 and 31 weeks of gestation by nonimmune hydrops fetalis nih. Do what is necessary to proactively treat the patients pain, and notify the md as appropriate of changes or an inability.
Department of paediatric surgery, university general hospital, patras, greece. A previously healthy 3weekold boy presented with 5 hours of marked fussiness, abdominal distention, and poor feeding. Clinical characteristics of abdominal distention in early. Nec, the most common acquired acute gastrointestinal illness in the neonatal period, affects about 5% of infants with birthweight. He was referred to the emergency department in which an abdominal radiograph revealed gaseous distention of the bowel with a. Extravasation of femoral venous catheter leading to ascites is a rare entity. A 1dayold newborn presents with abdominal distension figure 1. His prenatal examinations had been unremarkable and polyhydramnios had been absent. A rare cause of abdominal distention during pregnancy. Feb 17, 2020 note the abdominal distention prior to gastrostomy tube placement, and resolution of the distention and atelectasis after placement of the gastrostomy tube. At 6 hours after birth, the infant developed abdominal distension and had two episodes of projectile vomiting.
Outcomes of fullterm infants with bilious vomiting. Respiratory distress and abdominal distension in an 8month. Children swallow a large amount of air when they cry and gastric distension may require nasogastric tube decompression. Feeding intolerance in preterm infants and guidelines.
On presentation at our hospital, the infant was nontoxic and in no acute. Ultrasonography deomonstrates a dilated, fluid filled stomach and proximal duodenum. Management strategies for abdominal bloating and distension. Abdominal distention is a common disorder in newborns, which can be lifethreatening in severe cases. Abdominal radiographs, abdominocentesis and abdominal ultrasonography can further define the cause of abdominal distension. Abdominal circumference was measured before feeding and 1 hour post feeding. Clinical examination revealed a distended abdomen with hepatomegaly liver span. Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination, or detected on abdominal imaging. Gallbladder distension in septic neonates article pdf available in archives of disease in childhood 571. However, like in other reports, common features were the infusion of pn and inability to aspirate the blood back from the femoral venous line. There is a broad differential for an infant with abdominal distension, vomiting, abdominal pain, fever, and increased work of breathing. Active perinatal management, early treatment of primary pathologies, and protection of the stomach against distension in neonates at risk are essential in the management of neonatal.
Neopeptine causing abdominal distension in newborn download here free healthcaremagic app to ask a doctor all the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Careful history taking and abdominal examination are essential. Although three or fewer dilated bowel loops are typically seen with high intestinal obstruction, more than three are generally seen with low intestinal obstruction in neonates. The term abdominal distension is used to describe a few different possible conditions, relating to both the perception that bloating is occurring in the stomach and also actual physical bloating with a noticeable increase in the size of the stomach. For evaluation and diagnosis, intestinal obstruction in neonates can be divided into either high or low obstruction on the basis of the number of dilated bowel loops present on the initial abdominal radiographs. Patient presentation a 10yearold male came to the emergency room with a several day history of abdominal distension and generalized abdominal pain. Feeding intolerance fi, defined as the inability to digest enteral feedings associated to increased gastric residuals, abdominal distension andor emesis, is frequently encountered in the very preterm infant and often leads to a disruption of the feeding plan. Necrotizing enterocolitis nec is one of the most common gastrointestinal emergencies in the newborn infant.
It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. There are many different things that can cause abdominal pain, whose pathophysiology can differ widely. A good rule of thumb is that approximately 70% of normal term neonates pass meconium on the first day of life, and 98% will have done so by the end of the second day. A newborn with abdominal pain american academy of pediatrics. Abdominal distension in an infant gastroenterology. Extravasation of femoral venous catheter leading to ascites is a. The patient and family could provide few details but the pain was located periumbilically, occurred only during the day and would come and go.
Active perinatal management, early treatment of primary pathologies, and protection of the stomach against distension in neonates at risk are. Neonates and especially prematures have a relatively weak abdominal wall and inguinal hernias are common, especially in boys. Diagnosing acute intraabdominal emergencies in infants can be challenging at the best of times. He was also grunting and cried during abdominal palpation. At 20 days of life, the patient presented with a clinical picture of. Abdominal distention american academy of pediatrics. Jul 10, 2015 a 2 day old full term boy was referred to our hospital with respiratory distress and abdominal distension. Note the abdominal distention prior to gastrostomy tube placement, and resolution of the distention and atelectasis after placement of the gastrostomy tube. George abdenour discusses abdominal distention in neonates and the normal abdominal radiograph. Pn is usually given via either peripherally inserted central lines or umbilical venous lines. Respiratory distress and abdominal distension in an 8. Abdominal ultrasonography showed massive ascites and diffuse. Jul 21, 2014 patient presentation a 10yearold male came to the emergency room with a several day history of abdominal distension and generalized abdominal pain.
The nonpathological distention often seen in infants and toddlers may exceed the mild distention seen with an intraabdominal malignancy. The causes of pediatric abdominal masses are extensive, ranging from benign to neoplastic, and often originating from organs within the intraabdominal cavity table. A ventilated newborn with respiratory distress, abdominal. Occasionally, central venous catheters cvcs are inserted in the femoral veins. Abdominal examination an overview sciencedirect topics. A neonate with abdominal distension and failure to thrive. On presentation at our hospital, the infant was nontoxic and in no acute distress, but febrile 38. The following list of conditions have abdominal distention or similar listed as a symptom in our database. A fiberglass tape measure seca 201 was placed at the iliac crest level posteriorly and 1 cm above umbilicus anteriorly, with the baby in a supine totally horizontal position. Just 1 month prior, the infant presented in a similar fashion with a distended abdomen, but was discharged home from an outside hospital diagnosed with a presumed viral illness. His examination was remarkable for localized abdominal tenderness and distention.
Plain radiograph in a neonate with abdominal distension the bmj. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension vomiting, slow breathing and diarrhoea as danger signs in neonates. Abdominal distention can be a challenging clinical problem. Abdominal radiographs in neonates with meconium ileus usually show a pattern of low intestinal obstruction that is characterized by multiple bowel loop dilatations. Commonly, a baby may take initial feeds well, but then refuses feeds and starts to vomit e milk initially, becoming green bile. Intestinal gas endogenous gas production via the fermentation of luminal contents is a significant contributor to raised intraabdominal volume. Abdominal massage was applied to the massage group. Management of abdominal distension in the preterm infant with.
An infant with abdominal pain may present early with poor feeding, crying, or irritability. Electrolyte abnormalities are common in patients with puv. Abdominal pain can be classified as either acute or chronic. Always seek prompt professional medical advice about the cause of any symptom. Abdominal distension is a common clinical presentation in neonates admitted to neonatal intensive care units nicus, especially preterm infants. Ominous late findings often include lethargy, vomiting, or unresponsiveness. The aim of this study was to evaluate the efficacy of abdominal massage on feeding tolerance in stable preterm infants fed minimal enteral nutrition. Abdominal distension occurs when substances, such as air gas or fluid, accumulate in the abdomen causing its expansion.
Abdominal distention and renal failure in a neonate. Results of 163 neonates with bilious vomiting, 75 46% had a surgical diagnosis and 23 14. Some patients may be asymptomatic while others may present with a toxic appearance owing to abdominal distension secondary to bladder distention or urinary extravasation. The study was conducted on a controlgrouped pretest, posttest quasiexperimental design at the neonatal intensive care unit of a university hospital in turkey between march and july 2012. There are no statistical definitions of distention available to pediatricians. A 3monthold caucasian girl presented with a neonatal history of abdominal distension. Abdominal distension is a visible increase in abdominal girth, which can be measured by tape, xray, computed tomography, and abdominal inductance plethysmography. More than half of the caregivers recognized fever, irritability, weakness, abdominal distensionvomiting, slow breathing and diarrhoea as danger signs in neonates. He was transferred to the neonatal intensive care unit nicu for further evaluation. Therefore, a careful systematic approach should be used whenever concerns about abdominal distention are raised.
The causes of pediatric abdominal masses are extensive, ranging from benign to neoplastic, and often originating from organs within the intra abdominal cavity table. Abdominal distension may result from accumulation of gas and fluid in the gi tract or accumulation of urine, blood or excessive peritoneal fluid in the abdominal cavity. Plain radiograph in a neonate with abdominal distension. People suffering from this condition often describe it as feeling bloated. Neonatal sepsis is the most common diagnosis encountered. Common causes include duodenal, jejunal, ileal, or colonic atresia, malrotation with mid gut volvulus, meconium ileus with associated cystic fibrosis, meconium plug, hirschsprungs disease, imperforate anus, and hypoplastic left colon. Abdominal pain can be a very minor issue that is easily resolved, or a medical emergency.
Abdominal examination includes observation of external signs, then palpation for tenderness, distension, or firmness. Although more commonly associated with hydatidiform mole and multiple gestation, massive thecallutein cysts hyperreactio luteinalis occasionally complicate normal pregnancy. Step procedure serial transverse enteroplasty converts a short dilated segment of intestine into a longer narrower segment. Intestinal obstruction in the newborn differential diagnoses.
In case of multiple dilated bowel loops on the radiograph, always check the groins for the presence of a hernia containing a bowel loop figure. Sep 01, 2014 a 1dayold newborn presents with abdominal distension figure 1. The underlying causes are multiple and range from simple transient etiologies to lifethreatening events with significant morbidities. In the uk, neonatal surgery is carried out by specialist paediatric surgeons in a few tertiary referral centres. To measure abdominal distension, abdominal circumference was obtained. Abdominal xray and contrast studies are useful studies in identifying the cause and level of obstruction. A ventilated newborn with respiratory distress, abdominal distension and scrotal swelling professor xenophon sinopidis department of paediatric surgery, university general hospital, patras, greece.
This computergenerated list may be inaccurate or incomplete. One half of the neonates with duodenal atresia or stenosis are born prematurely. Approach to pediatric abdominal pain learn pediatrics. Lactulose, which is poorly absorbed in the small bowel and therefore fermented in the colon, has been shown to be associated with bloating and distension in healthy volunteers 1 and in patients with chronic. Nov 14, 2014 the aim of this study was to evaluate the efficacy of abdominal massage on feeding tolerance in stable preterm infants fed minimal enteral nutrition. Abdominal distension refers to the swelling of the abdomen. Constipation, but it is important to pick up on the. Central venous lines are an essential part of neonatal intensive care and are used for infusion of medications and parenteral nutrition pn. On physical examination, her abdomen was massively distended, with bulging flanks, and was dull to percussion.
Dayold newborn with abdominal distension american academy. Management of abdominal distension in the preterm infant. The distension may be caused by either air gas or fluid collection. Sufferers often experience a sensation of fullness, abdominal. Abdominal distension is more pronounced with distal lesions as compared to proximal duodenal atresia. Causes of abdominal distention in late pregnancy include polyhydramnios, intestinal obstruction, and ascites.
Venous access gastric decompression placement of orogastric tube gastric distension can compromise ventilatory efforts fluid resuscitation broad spectrum antibiotic coverage prevention of hypothermia. Effect of abdomen massage for prevention of feeding. It is a disorder characterized by ischemic necrosis of the intestinal mucosa, which is associated with severe inflammation, invasion of enteric gas forming organisms, and dissection of gas into the bowel wall and portal venous system 1. Therefore, consideration of ap should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic hd. He was transferred to the neonatal intensive care unit nicu for further. Upper quadrant ecchymosis, tenderness, and associated rib fractures suggest the presence of liver or spleen. A 9monthold girl presented to the emergency department with abdominal distension.
In this patient, it is most important to identify and evaluate potential lifethreatening intraabdominal pathologies including malrotation with midgut volvulus, incarcerated inguinal hernia, adhesions with. The timing of transfer is a key consideration in managing neonates with surgical conditions. At 48 h of life, the physical examination revealed jaundice, which was treated successfully with conventional phototherapy for 24 h, and mild hepatomegaly, which was not promptly investigated. The majority of pediatric abdominal complaints are relatively benign e. Abdominal ultrasonography showed massive ascites and diffuse edematous bowel wall.
Currently, little literature is available regarding early identification of the etiology of this disorder in newborn babies, which is imperative to reducing the likelihood of serious consequences. In this patient, it is most important to identify and evaluate potential lifethreatening intra abdominal pathologies including malrotation with midgut volvulus, incarcerated inguinal hernia, adhesions with. Abdominal distension causes, symptoms, diagnosis, treatment. Early diagnosis is associated with a substantially better outcome and. Although three or fewer dilated bowel loops are typically seen with high intestinal obstruction. At physical examination he had tachypnoea and abdominal distension. Clinical assessment will usually indicate the nature of abdominal distension ie whether ascites, gastrointestinal gas, pregnancy, etc but further investigations are often required to determine the precise aetiology. Despite the marked intestinal dilatations, there is often a relative lack of airfluid levels within the dilated bowel loops because of the abnormally thick intraluminal meconium.
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