Question

A 24-hour old male neonate is due for discharge home post delivery and requires a full examination. Describe how you will examine the gastrointestinal system (only) of the baby prior to discharge home

Answer 1

Abdominal examination in neonates needs to be done soon after birth as well as before discharge. As any assessment has two parts, it also has history collection and physical examination which helps us to understand a lot of diagnosis from the complaints.

History collection. The mother should be asked about any history of vomiting, abdominal distention and passage of meconium.

Vomiting.

Bilious vomiting occurs inmalrotation, mid gut vulvulus and small bowel obstruction. Projectile vomiting is caused due to pyloric stenosis.

Abdominal distention associated with bloody stools and emesis indicates necrotizing enterocoliltis.

Physical examination.

Technique. Perform abdominal examination with infants hips and knees flexed. It helps to relax the abdomen.

Findings. Scaphoid abdomen is usually seen in diaphragmatic hernia.

Observe for abdominal wall defects such as diastasis recti, umbilical hernia, gastrrochisis and omphalocele.

Persistent abdominal distention can be due to either abdominal mass, renal mass(wilms tumour, renal vein thrombosis, multicystic dysplastic kidney, hydronephrosis)

Observe the umbilicus for infection, single artery umbilical cord. Instruct them that nothing should be applied and it falls by its own 10 th day.

Anus. Patency and passage of meconium within 24 to 48 hours of birth. Failure can be due to congenital aganglionic megacolon or hirshspungs disease.