Hirut Eyob, IBCLC <[log in to unmask]> wrote:

> Hi, I would appreciate some help on this case.
> 
> Baby was ok with colostrum but has been vomiting (yellow-green) at every
> feeding since she got home ~48 after birth.Baby got admitted to the
> hospital last night (day 8) because she continues to vomit and lose
> weight.
> 
> Birth weight 6.10;at discharge(day two) 6.04; at day eight 6.02 Baby
> vomits every feeding regardless of the quantity fed or the duration of
> feeding. Hospital did a series of tests: basic blood and ultrasound were
> normal. Mom was told to stop breastfeeding and give baby Pedialyte but
> baby continued to vomit. When baby was only on IV she experienced no
> vomiting. Other tests were conducted a couple of hours ago: culture and
> spinal tap but results won't be available for another 48 hours.
> Preliminary result shows the fluid in the spinal tap to be clear. Baby is
> in the meantime being treated with antibiotics and has started
> breastfeeding 10 ml from a bottle. She continues to vomit but mother is
> giving her the milk every 20 min.
> 
> Mother is not taking any medications and the birth was normal. The older
> sibling had severe acid re-flux, therefore mother introduced formula early
> because she felt that she tolerated it better than breast-milk. The 14
> month old just got diagnosed with asthma
> 
> Has anyone experiences a similar case? It's devastating to see a newborn
> subjected to so many interventions and still have no answer.

Is a specialist neonatal paediatric surgeon involved, in a
tertiary-level paeds hospital? I would be VERY worried about a midgut
malrotation with the risk of an impending volvulus, if this is truly
neonatal bilious vomiting developing on this time course.  Does the
vomit look a bit like this?

http://newborns.stanford.edu/PhotoGallery/Bile1.html

Abdo X-rays? Repeat ultrasound with a very experienced/specialised tech?
What do the bloods say now? Has the baby been stooling at all? Is the
abdomen distended? How sick is the baby clinically? Have the various
causes of intestinal obstruction been conclusively ruled out?

(You don't have to answer all these questions - but it would be good if
someone on the medical team is making sure they are being asked.)

Lara Hopkins

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