Case 1: A Well-Growing Neonate with Features of Intestinal Obstruction

Abstract

A 1,555-g, first of twin female infants is born at 38 4/7 weeks to a 24-year-old primigravida in a vaginal delivery through clear amniotic fluid. The infant is small for gestational age (<10th percentile on the Fenton intrauterine growth chart) with features of intrauterine malnutrition, such as triangular facies and loose skinfolds. The antenatal period is uneventful. The infant needs only basic steps at birth, with Apgar scores of 9, 9, and 9 at 1, 5, and 10 minutes, respectively. In view of the low birthweight, the neonate is transferred to the NICU and placed under the warmer with servo skin mode. Full tube feeding is initiated under observation. The infant passes meconium on the first postnatal day at 18 hours of age and has a normal stool transition. She tolerates feeds well until day 6 after birth, with an expected weight loss of 1.2% per day. On the sixth postnatal day, she has abdominal distention (an increase in girth of 3 cm) with multiple episodes of vomiting. On evaluation, she is found to be euthermic (temperature of 98.9°F [37.2°C]), euglycemic (glucose concentration of 64 mg/dL [3.5 mmol/L]), normocalcemic (calcium concentration of 4.04 mg/dL [1.01 mmol/L]), with no evidence of any systemic illness. Hence, surgical causes like volvulus, Hirschsprung disease, meconium ileus, and acute/subacute intestinal obstruction are the …