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What are the signs that an infant's vomiting may be caused by or lead to a serious condition?
There are many clinically serious causes of infant
vomiting, or emesis. Identification is initially a process of elimination. Routine"spit-up," in small amounts that tends to diminish in frequency isn't a cause for alarm. However, a potential mechanism underlying spit-ups, gastroesophageal reflex (GER), can lead to serious problems if complications arise. Gastroesophageal reflux disease (GERD) can result in failure to gain weight, bleeding, respiratory problems or esophagitis. Symptoms include frequent vomiting, pain upon regurgitation and refusal to feed. Any sign of GERD warrants referral to a specialist.
But not all vomiting can be attributed to reflux. A minority of infant vomiters do need urgent, or even emergent, surgical management. For example, all neonatal bilious emesis is a
surgical emergency until proven otherwise. Bilious vomit is green in color, and may indicate an acute bowel obstruction from a midgut volvulus from the congenital condition known as malrotation. Malrotation is often "silent" in newborns until a volvulus occurs. Intestinal obstruction from incarcerated hernias, meconium ileus, intussusception, Hirschsprung's disease, intestinal stenoses, and appendicitis are also possible causes. In these rare cases, time is of the essence. Without
immediate surgical intervention, the sequelae of a missed diagnosis can be fatal.
At Children's, specialists have access to imaging (KUB),
as well as intestinal contrast studies (upper and/or lower
GI studies), so one can obtain images to assess for intestinal blockages if time allows. For the office pediatrician, key
indications for emergent surgical referral include the
presence of green, bilious vomiting-a suggestion of bowel obstruction. Urgent referral for severe or persistent
constipation and pathologic GERD is welcomed. Understanding the difference between the common newborn "spit-up" from severe GERD or an intestinal obstruction from malrotation can save lives.
- Terry L. Buchmiller, MD, staff surgeon
More information:
childrenshospital.org/surgery
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