Vomiting is a common manifestation in the neonates.

 

 

INTRODUCTION

 

 

          Vomiting is one of the common manifestation in the neonate persistent vomiting may be serious ether be trivial or manifestation of some graver pathology this may result in dehydration and electrolyte imbalance mucus vomiting tinged with blood is quite common soon after birth. It is due to irritation of the gastric mucosa by the swallowed material during birth.

 

 

Definition

        It is the forcible exaction of gastric content, via the esophagus and mouth.

 

Etiology

a)     Contaminated  food and infections

b)    In case of gastro esophageal reflux, the infant regurgitates frequently.

c)     In case of pyloric stenosis the vomiting is projectile

The colour of the vomiting is important in determining the source and causation.

Ø     Uncurdled or unchanged food containing no gastric juice originated in the esophagus.

Ø     Curdled milk containing gastric juice originated in the stomach.

Ø     Greenish coloured vomiting indicates the presence of bile pigments due to intestinal obstruction.

Ø     Fecal colour and odour indicates the vomitus originated low in the intestinal obstruction or peritonitis.

Ø     Blood in the vomitus may be red, if it is originated high in the gastrointestinal tract or resemble coffee grounds if it has been mixed with digestive juices.

 

 

Other causes are

Ø     Gastric irritation

Ø     Toxic effect on vomiting center

Ø     Reflex vomiting

Ø     Obstruction to alimentary tract

Ø     Increased intracranial tension

Ø      Metabolic disorders

Ø     Emotional disturbances  

Ø     Milk allergy

Types of vomiting

A.    Bile stained.

This is seen in.

a)           Distal duodenal obstruction

b)          Malrotation

c)           Intestinal obstruction   

B.   Non-bile stained and projectile

This is seen in

a)           Hypertrophy

b)          Congenital adrenal hyperplasia 

c)           Haitus hernia  

 

C.   Non-bile stained and non-projectile

This is seen by

a)           Infection

b)          Increased intra cranial pressure  

c)           Proximal duodenal atresia

d)          Feeding problem

e)           Uraemia

 

 

 

 

 

 

 

 

 

Pathophysiology

 

        Vomiting center is situated in the reticular core of the medulla oblongata gets executed by impulse.

 

 

Stimulation received by afferent impulse

 

Mechanical stimuli such as

a) Increased icp

b) Disturbances of semicircular canal of inner ear

 

Vomiting

 

During vomiting

 

Duodenum contract in spasm

 

Through sharp contraction of the abdominal musculature

 

Stomach forcefully empties

 

 

Clinical manifestation

Ø     Electrolyte fluid imbalance

Ø     Weight loss

Ø     Tachycardia

Ø     Hypovolemia

Ø     Dehydration

Ø     Metabolic change (Hypernatraemia, Hypocalcemia)

Ø     Fatigue

Ø     Tachy pnoea

 

Diagnostic evaluation

        The newborn who have persistent vomiting must be carefully evaluated to determine the cause.

 

The diagnostic evaluation is:

Ø     History from parents

Ø     Physical examination

Ø     Laboratory lest

Ø     X-ray

Ø     Daily checking of weight, urinary output etc

 

Management

Medical management

 

        Vomiting is only a symptom of illness and management is corrected towards detecting and treating the cause.

 

1.    Parenteral fluid and electrolyte therapy may be indicated to correct the resulting dehydration and alkalosis.

2.    Anti-emetic drugs may be given to control vomiting          eg. Stemetil, domstal, emset, perinorm.

3.    In case of obstruction the child should be given nothing by mouth and aspiration by nasogastric tube is necessary.

 

Nursing Management

             i. The nurse should check the vital sign regularly.

           ii. The nurse should advice the mother to clean the child.

        iii. Recording of urinary output and specific gravity of urine can assist in establishing diagnosis and evaluating complication.

         iv. If the problems is one of the improper feeding techniques, the nurse should teach the parents about corrector feeding technique.

           v. The nurse should prescribe a balance formula, if the problem is caused by incorrect composition of the formula.

         vi. Monitor intake and output chart.

      vii. Advice not to stop breast feeding.

    viii. In order to prevent the aspiration of vomitus, the nurse should turn the head of the child to one side so that it can run into a kidney basin.

        ix.The face, skin behind the ears and neck should be kept clean and dry.

           x. In case of hypovolemia.

o       Nurse should check the vital signs

o       Maintain fluid and electrolyte balance

o       Oxygen saturation should be checked

o       Cardiac monitoring should be done

o       Observe for any signs and symptoms of shock    

        xi. In case of dehydration

o       Check for skin turgor

o       Check the mental status of child

o       Observe for any cyanosis

o       Check the vital sings intervally

o       Check the weight of the baby. 

 

CONCLUSION

         

          Vomiting is a common manifestation in the neonates. Vomiting in neonates may be the manifestation of some graver pathology. All vomits should be checked for the presence of bile or blood. Keen observation of the infants for other sings such as abdominal distension, watery or blood stained stools and temperature instability. Vomiting in neonates,  its definition, etiology, types, pathophysiology, clinical manifestation, diagnostic evaluation and management are clearly substantiated in this presentation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIBLIOGRAPHY

 

1)              Annamma Jacob; a comprehensive textbook of midwifery.      

            Jaypee publishers (P) Ltd; New Delhi.

            II^nd Edition.

            P.No.611-612.

2)         V.Ruth Bennett, Linda.K.Brown,

            MYLE’S TEXTBOOK FOR MIDWIVES,

            Churchill Livingston

            14^th Edition

            P.no.806-807