09-22-2010, 04:14 PM
The nurse from the level 2 neonatal intensive care nursery calls you to evaluate a baby. The infant, born at 32 weeks' gestation, is now 1 week old and had been doing well on increasing nasogastric feedings. This afternoon, however, the nurse noted that the infant has vomited the last two feedings and seems less active. Your examination reveals a tense and distended abdomen with decreased bowel sounds. As you are evaluating the child, he has a grossly bloody stool. Your initial management of this infant should include which of the following?
1. Surgical consultation for an emergent exploratory laparotomy
2. Continued feeding of the infant, as gastroenteritis is usually self-limited
3. Stool culture to identify the etiology of the bloody diarrhea and an infectious diseases consultation
4. Stopping feeds, beginning intravenous fluids, ordering serial abdominal films, and initiating systemic antibiotics
5. Upper GI series and barium enema to evaluate for obstruction
1. Surgical consultation for an emergent exploratory laparotomy
2. Continued feeding of the infant, as gastroenteritis is usually self-limited
3. Stool culture to identify the etiology of the bloody diarrhea and an infectious diseases consultation
4. Stopping feeds, beginning intravenous fluids, ordering serial abdominal films, and initiating systemic antibiotics
5. Upper GI series and barium enema to evaluate for obstruction