Index of Suspicion in the Nursery

Abstract

A 3-day-old African-American baby boy born at 35 weeks’ gestation presents with a 2-day history of increasing feeding refusal and abdominal distention. He has not had a bowel movement since birth. He is otherwise stable and healthy. He was born to a 24-year-old primigravida who had gestational diabetes. There were no risk factors for sepsis or exposure to maternal medications, including magnesium. Aside from vacuum assistance, it was an uncomplicated spontaneous vaginal delivery. The infant had an unremarkable neonatal resuscitation and transition, with Apgar scores of 8 and 8 at 1 and 5 minutes, respectively. He has no family history of cystic fibrosis, Hirschsprung disease (HD), metabolic disorders, or endocrine disease. The review of his systems shows no unusual findings. He has normal vital signs but is relatively large for gestational age at 3.8 kg. Other significant findings on physical examination include high-pitched bowel sounds and a hypertympanic, distended abdomen that has increased from 32 cm at birth to 38 cm. There are no palpable loops. The abdomen is otherwise soft, nontender, and without mass or organomegaly. The anus is normally placed and patent. His neurologic examination findings are normal. An abdominal radiograph shows multiple dilated loops …