volvulus related to malrotation of the midgut (this is potentially the most dangerous).There are many causes of bowel obstruction including: Vomiting bile Suspect bowel obstruction if bile is greenĪ baby who vomits bile (green, not yellow) should be presumed to have a bowel obstruction, until proven otherwise. Contact local pathology service if this is required. This distinguishes fetal from adult haemoglobin. Usually the origin of the blood is clear from the history, but if there is doubt some laboratories may be able to perform an Apt test (blood mixed with sodium hydroxide). Stress ulceration babies who are very sick can have stress ulceration of the stomach, as can those treated with drugs such as corticosteroids and indomethacin.īabies can swallow their own blood from upper airway trauma, which may occur from:īabies with gastro-oesophageal reflux can develop reflux oesophagitis, which may bleed.Babies whose mothers have been taking medications that interfere with vitamin K metabolism (such as anticonvulsants or oral anticoagulants) or babies with liver disease or consumption of clotting factors are at higher risk. Haemorrhagic disease of the newborn (HDN) - this rarely occurs with adequate vitamin K prophylaxis.This becomes a transient contraindication to breastfeeding if the mother is hepatitis C positive. The mother's cracked and bleeding nipple will require attention, and she may require lactation advice about nipple attachment. If it is swallowed from birth it will eventually clear from the GIT occasionally in the form of mild malaena. Management of swallowed maternal blood is expectant. Usually the mother is aware of the nipple problem, but not always, as the bleeding may be deeper and painless. Many breastfed babies will swallow blood from a cracked and bleeding nipple. Under these circumstances, as well as vomiting blood, the baby may pass malaena stools, rather than meconium. This blood may then take several days after birth to clear the gastrointestinal tract (GIT). However, the largest amount of blood will be swallowed if there is an antepartum haemorrhage associated with bleeding into the amniotic fluid for at least several hours before birth. No birth is bloodless, whether vaginal or Caesarean, and hence there is the opportunity to swallow blood at birth. Blood may be swallowed during:įigure 3: Vomited blood (Photo courtesy of Janelle Aby MD) The commonest cause of vomit containing blood is swallowed maternal blood. Swallowed blood often irritates the stomach and causes vomiting. Figure 2: Vomited colostrum (Photo courtesy of Janelle Aby MD) In a breastfed baby a small amount of yellow vomiting as opposed to (lime) green vomiting may be due to colostrum rather than bile and is usually benign if the amount and frequency are small. Small, frequent vomits are referred to as 'possets'. If none of the above clinical scenarios apply, the vomiting is unlikely to be clinically significant. the baby is dehydrated (dry mouth, decreased wet nappies, hypotonic).the baby has gastrooesophageal reflux and could be aspirating.vomit contains blood (red or black, the colour of the blood will depend upon how long the blood has been in the stomach)įigure 1: Bile vomitus (Photo courtesy of Janelle Aby MD).Vomiting may be clinically significant if: However, there are circumstances when the type of vomiting is important. In most cases this is unimportant and rarely persists beyond the first few feeds. Vomiting or more often, regurgitation is a relatively frequent symptom during the newborn period. Vomiting in the neonate covers different types of vomiting, and links to specific causes of vomiting requiring management. Many babies vomit at some time and in most cases this is unimportant. We recommend that you also refer to more contemporaneous evidence in the interim. Please note that all guidance is currently under review and some may be out of date.
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