Green vomiting in the first 72 hours in normal infants

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Diagnostic Imaging

Background:

• Bilious vomiting in newborns is a concerning symptom requiring prompt evaluation.
• Differentiating between surgical and non-surgical causes is critical for timely intervention.

Purpose of the Study:

• To prospectively evaluate newborns with bilious vomiting within the first 72 hours of life.
• To assess the diagnostic utility of initial plain abdominal roentgenograms in identifying surgical lesions.
• To determine the necessity of contrast studies in neonates presenting with bilious vomiting.

Main Methods:

• Prospective follow-up of 45 newborns (weight >= 2000 g) presenting with bilious vomiting.
• Analysis of initial plain abdominal roentgenogram findings.
• Correlation of imaging findings with surgical or non-surgical outcomes.
• Evaluation of contrast studies in identifying specific pathologies.

Main Results:

• 20% of newborns required surgical intervention; 11% had non-surgical obstruction; 69% had idiopathic bilious vomiting.
• Idiopathic cases showed a benign, transient course.
• Plain abdominal roentgenograms had normal/nonspecific findings in 56% of neonates with surgical lesions.
• Specific roentgenogram findings were present in 5 infants, 4 of whom had surgical lesions (80%).

Conclusions:

• While most cases of neonatal bilious vomiting are idiopathic, a significant percentage represent surgical emergencies.
• Initial plain abdominal roentgenograms have limited sensitivity in detecting surgical lesions.
• Contrast studies are essential for identifying surgical causes of bilious vomiting, with 56% of surgical cases potentially missed without them.