Vomiting in a Newborn Baby

Vomiting or, more often, regurgitation is a relatively frequent symptom during the neonatal period. In the 1st few hours after birth, infants may vomit mucus, occasionally blood streaked. This vomiting rarely persists after the 1st few feedings; it may be due to irritation of the gastric mucosa by material swallowed during delivery. If vomiting is protracted, gastric lavage with physiologic saline solution may relieve it.

When vomiting occurs shortly after birth and is persistent, the possibilities of intestinal obstruction, metabolic disorders, and increased intracranial pressure must be considered. A history of maternal polyhydramnios suggests upper gastrointestinal (esophageal, duodenal, ileal) atresia. Bile-stained emesis suggests intestinal obstruction beyond the duodenum, but may also be idiopathic.

Obstructive lesions of the digestive tract are the most frequent gastrointestinal anomalies.

Vomiting from esophageal obstruction occurs with the 1st feeding. The diagnosis of esophageal atresia can be suspected if unusual drooling from the mouth is observed and if resistance is encountered during an attempt to pass a catheter into the stomach. The diagnosis should be made before the infant has trouble with oral feedings and develops aspiration pneumonia.

Infantile achalasia (cardiospasm), a rare cause of vomiting in newborn infants, is demonstrable roentgenographically by obstruction at the cardiac end of the esophagus without organic stenosis. Regurgitation of feedings because of continuous relaxation of the esophageal-gastric sphincter, or chalasia, is a cause of vomiting. Keeping the infant in a semi-upright position, thickening the feeding, or administering prokinetic drugs can control it.

Vomiting because of obstruction of the small intestine usually begins on the 1st day of life and is frequent, persistent, usually non-projectile, copious, and, unless the obstruction is above the ampulla of Vater, bile stained; it is associated with abdominal distention, visible deep peristaltic waves, and reduced or absent bowel movements.

Malrotation with obstruction from midgut volvulus is an acute emergency that not only must be considered but also urgently evaluated by an upper gastrointestinal contrast series. X-rays of the abdomen show the distribution of air in the intestine, which may point to the anatomic location of an obstruction; malrotation can be identified only by contrast studies. Normally, air can be demonstrated by x-ray in the jejunum by 15–60 min, in the ileum by 2–3 hr, and in the colon by 3 hr after birth.

Persistent vomiting may occur with congenital diaphragmatic hernia.

The vomiting associated with pyloric stenosis may begin any time after birth but does not assume its characteristic pattern before the 2nd–3rd wk.

Vomiting with obstipation is a common early sign of Hirschsprung disease.

Other Causes:

Vomiting may occur with many other disturbances that do not obstruct the digestive tract, such as milk allergy, adrenal hyperplasia of the salt-losing variety, galactosemia, hyperammonemias, organic acidemias, increased intracranial pressure, septicemia, meningitis, and urinary tract infection. In many infants, it is simply regurgitation from overfeeding or from failure to permit the infant to eructate swallowed air.