Neonatal Gastrointestinal Emergencies

Authors

DOI:

https://doi.org/10.58427/apghn.3.1.2024.41-57

Keywords:

emergency, gastrointestinal, neonates

Abstract

Background: Neonatal gastrointestinal emergencies refer to a set of life-threatening conditions affecting the digestive system of a newborn within the first 28 days of life and often associated with high morbidity and mortality. As such, these conditions require immediate and accurate diagnosis as well as proper treatment to optimize the outcomes of these patients. This condition has the potential to obstruct the flow of gastric content leading to vomiting, failure to thrive, and electrolyte imbalances.

Discussion: Gastrointestinal obstruction is one of the most common conditions causing emergency condition in neonates. This condition may occur anywhere between the upper part of gastrointestinal tract to the lower gastrointestinal tract. In most cases of neonatal gastrointestinal emergencies, patients almost always present with vomiting that may be bilious or non-bilious. Furthermore, persistent vomiting may also lead to a more severe consequences such as hypovolemic shock and electrolyte imbalances. Therefore, clinicians are expected to address this problem early while also working to find the underlying etiologies of neonatal vomiting. On the other hand, gastrointestinal bleeding is often an alarming sign that indicates a possible emergency condition in neonates. However, some non-emergency condition such as swallowed maternal blood and cow's milk allergy can also result in gastrointestinal bleeding in neonates.

Conclusion: Given the critical time window and the vulnerability of the neonate population, the proper identification and prompt treatment of neonatal gastrointestinal emergencies is crucial to minimize morbidity and mortality. Multidisciplinary management with neonatologists, pediatric surgeons, radiologists, and nursing staff working closely together can provide the best possible outcomes.

References

Organization WH. Newborns: improving survival and well-being. 2020

Sampurna MTA, Handayani KD, Utomo MT, Angelika D, Etika R, Harianto A, et al. Determinants of neonatal deaths in Indonesia: A national survey data analysis of 10,838 newborns. Heliyon. 2023;9(1):e12980.https://doi.org/https://doi.org/10.1016/j.heliyon.2023.e12980 DOI: https://doi.org/10.1016/j.heliyon.2023.e12980

Stanescu AL, Liszewski MC, Lee EY, Phillips GS. Neonatal gastrointestinal emergencies: step-by-step approach. Radiologic Clinics. 2017;55(4):717-39 DOI: https://doi.org/10.1016/j.rcl.2017.02.010

Juang D, Snyder CL. Neonatal bowel obstruction. Surg Clin North Am. 2012;92(3):685-711, ix-x.https://doi.org/10.1016/j.suc.2012.03.008 DOI: https://doi.org/10.1016/j.suc.2012.03.008

Parashette KR, Croffie J. Vomiting. Pediatr Rev. 2013;34(7):307-19; quiz 20-1.https://doi.org/10.1542/pir.34-7-307 DOI: https://doi.org/10.1542/pir.34.7.307

Kadim M. Gastroinstestinal Bleeding in Pediatrics. Archives of Pediatric Gastroenterology, Hepatology, and Nutrition. 2022;1(2):28-36 DOI: https://doi.org/10.58427/apghn.1.2.2022.28-36

Cassina M, Ruol M, Pertile R, Midrio P, Piffer S, Vicenzi V, et al. Prevalence, characteristics, and survival of children with esophageal atresia: A 32-year population-based study including 1,417,724 consecutive newborns. Birth Defects Res A Clin Mol Teratol. 2016;106(7):542-8.https://doi.org/10.1002/bdra.23493 DOI: https://doi.org/10.1002/bdra.23493

Crisera CA, Grau JB, Maldonado TS, Kadison AS, Longaker MT, Gittes GK. Defective epithelial-mesenchymal interactions dictate the organogenesis of tracheoesophageal fistula. Pediatr Surg Int. 2000;16(4):256-61.https://doi.org/10.1007/s003830050740 DOI: https://doi.org/10.1007/s003830050740

Krishnan U. Eosinophilic Esophagitis in Esophageal Atresia. Front Pediatr. 2019;7:497.https://doi.org/10.3389/fped.2019.00497 DOI: https://doi.org/10.3389/fped.2019.00497

Petrosyan M, Estrada J, Hunter C, Woo R, Stein J, Ford HR, et al. Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair. J Pediatr Surg. 2009;44(12):2278-81.https://doi.org/10.1016/j.jpedsurg.2009.07.047 DOI: https://doi.org/10.1016/j.jpedsurg.2009.07.047

Pinheiro PF, Simões e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol. 2012;18(28):3662-72.https://doi.org/10.3748/wjg.v18.i28.3662 DOI: https://doi.org/10.3748/wjg.v18.i28.3662

Ilce Z, Erdogan E, Kara C, Celayir S, Sarimurat N, Senyüz OF, et al. Pyloric atresia: 15-year review from a single institution. J Pediatr Surg. 2003;38(11):1581-4.https://doi.org/10.1016/s0022-3468(03)00565-7 DOI: https://doi.org/10.1016/S0022-3468(03)00565-7

Galea R, Said E. Infantile Hypertrophic Pyloric Stenosis: An Epidemiological Review. Neonatal Netw. 2018;37(4):197-204.https://doi.org/10.1891/0730-0832.37.4.197 DOI: https://doi.org/10.1891/0730-0832.37.4.197

Iqbal CW, Rivard DC, Mortellaro VE, Sharp SW, St Peter SD. Evaluation of ultrasonographic parameters in the diagnosis of pyloric stenosis relative to patient age and size. J Pediatr Surg. 2012;47(8):1542-7.https://doi.org/10.1016/j.jpedsurg.2012.03.068 DOI: https://doi.org/10.1016/j.jpedsurg.2012.03.068

Ranells JD, Carver JD, Kirby RS. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Adv Pediatr. 2011;58(1):195-206.https://doi.org/10.1016/j.yapd.2011.03.005 DOI: https://doi.org/10.1016/j.yapd.2011.03.005

Bašković M, Župančić B, Lesjak N, Vukasović I. Hypertrophic Pyloric Stenosis - Five-Year Retrospective Analysis. Acta Med Croatica. 2016;70(2):103-6

Morris JK, Springett AL, Greenlees R, Loane M, Addor M-C, Arriola L, et al. Trends in congenital anomalies in Europe from 1980 to 2012. PLOS ONE. 2018;13(4):e0194986.https://doi.org/10.1371/journal.pone.0194986 DOI: https://doi.org/10.1371/journal.pone.0194986

Yoon CH, Goo HW, Kim EA, Kim KS, Pi SY. Sonographic windsock sign of a duodenal web. Pediatr Radiol. 2001;31(12):856-7.https://doi.org/10.1007/s002470100005 DOI: https://doi.org/10.1007/s002470100005

McVay MR, Kokoska ER, Jackson RJ, Smith SD. Jack Barney Award. The changing spectrum of intestinal malrotation: diagnosis and management. Am J Surg. 2007;194(6):712-7; discussion 8-9.https://doi.org/10.1016/j.amjsurg.2007.08.035 DOI: https://doi.org/10.1016/j.amjsurg.2007.08.035

Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 2004;34(11):837-51.https://doi.org/10.1007/s00247-004-1279-4 DOI: https://doi.org/10.1007/s00247-004-1279-4

Catania VD, Lauriti G, Pierro A, Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(12):1157-64.https://doi.org/10.1007/s00383-016-3974-2 DOI: https://doi.org/10.1007/s00383-016-3974-2

Ben Ely A, Gorelik N, Cohen-Sivan Y, Zissin R, Carpineta L, Osadchy A, et al. Appendicitis in adults with incidental midgut malrotation: CT findings. Clin Radiol. 2013;68(12):1212-9.https://doi.org/10.1016/j.crad.2013.07.001 DOI: https://doi.org/10.1016/j.crad.2013.07.001

Cuna A, George L, Sampath V. Genetic predisposition to necrotizing enterocolitis in premature infants: Current knowledge, challenges, and future directions. Semin Fetal Neonatal Med. 2018;23(6):387-93.https://doi.org/10.1016/j.siny.2018.08.006 DOI: https://doi.org/10.1016/j.siny.2018.08.006

Gephart SM, Hanson C, Wetzel CM, Fleiner M, Umberger E, Martin L, et al. NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Matern Health Neonatol Perinatol. 2017;3:23.https://doi.org/10.1186/s40748-017-0062-0 DOI: https://doi.org/10.1186/s40748-017-0062-0

Geng Q, Wang Y, Li L, Guo C. Early postoperative outcomes of surgery for intestinal perforation in NEC based on intestinal location of disease. Medicine (Baltimore). 2018;97(39):e12234.https://doi.org/10.1097/md.0000000000012234 DOI: https://doi.org/10.1097/MD.0000000000012234

Seghesio E, De Geyter C, Vandenplas Y. Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis. Pediatr Gastroenterol Hepatol Nutr. 2021;24(3):245-55.https://doi.org/10.5223/pghn.2021.24.3.245 DOI: https://doi.org/10.5223/pghn.2021.24.3.245

Sathe M, Houwen R. Meconium ileus in Cystic Fibrosis. J Cyst Fibros. 2017;16 Suppl 2:S32-s9.https://doi.org/10.1016/j.jcf.2017.06.007 DOI: https://doi.org/10.1016/j.jcf.2017.06.007

Butler Tjaden NE, Trainor PA. The developmental etiology and pathogenesis of Hirschsprung disease. Transl Res. 2013;162(1):1-15.https://doi.org/10.1016/j.trsl.2013.03.001 DOI: https://doi.org/10.1016/j.trsl.2013.03.001

Martucciello G. Hirschsprung's disease, one of the most difficult diagnoses in pediatric surgery: a review of the problems from clinical practice to the bench. Eur J Pediatr Surg. 2008;18(3):140-9.https://doi.org/10.1055/s-2008-1038625 DOI: https://doi.org/10.1055/s-2008-1038625

Knowles CH, De Giorgio R, Kapur RP, Bruder E, Farrugia G, Geboes K, et al. Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol. 2009;118(2):271-301.https://doi.org/10.1007/s00401-009-0527-y DOI: https://doi.org/10.1007/s00401-009-0527-y

Hadidi A. Transanal endorectal pull-through for Hirschsprung's disease: a comparison with the open technique. Eur J Pediatr Surg. 2003;13(3):176-80.https://doi.org/10.1055/s-2003-41262 DOI: https://doi.org/10.1055/s-2003-41262

Langer JC, Durrant AC, de la Torre L, Teitelbaum DH, Minkes RK, Caty MG, et al. One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg. 2003;238(4):569-83; discussion 83-5.https://doi.org/10.1097/01.sla.0000089854.00436.cd DOI: https://doi.org/10.1097/01.sla.0000089854.00436.cd

Published

2024-02-29

How to Cite

1.
Neonatal Gastrointestinal Emergencies. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2024 Feb. 29 [cited 2024 Apr. 23];3(1):41-57. Available from: https://apghn.com/index.php/journal/article/view/59