08-22-2014, 06:53 AM
6. You are called to the neonatal unit of the hospital to evaluate a male neonate who is not breast-feeding well. The neonate was born 12 hours ago to a 27-year-old woman. He is the
mother's first child. He was born at term via uncomplicated vaginal delivery; he was vigorous at the time of delivery. The mother received appropriate prenatal care throughout her
pregnancy. She says that the neonate appears hungry, but soon after he latches onto the breast he gags and becomes uninterested in feeding. Vital signs now are temperature 37.0°C
(98.6°F), pulse 150/min, and respirations 40/min. On physical examination, the neonate is alert and active. Lungs are clear. Chest and abdomen are normal. Anus is patent. The neonate
has passed only a small smear of stool since birth.
On day 2 of life, the neonate continues to have problems with feeding. On physical examination now, he appears alert and vigorous. Abdominal girth is increased 3 cm (1.2 in) since birth.
The abdomen is distended, but it remains soft to palpation. The neonate has not passed any stool today. A nasogastric tube is inserted and less than 10 mL of clear, nonbilious
secretions with small flecks of brown blood are disclosed. Which of the following is the most appropriate next step?
~ A) Administer ranitidine
B) Administer sucralfate therapy
C) Do lower gastrointestinal barium study
D) Obtain plain x-ray of the abdomen
E) Order upper endoscopy
mother's first child. He was born at term via uncomplicated vaginal delivery; he was vigorous at the time of delivery. The mother received appropriate prenatal care throughout her
pregnancy. She says that the neonate appears hungry, but soon after he latches onto the breast he gags and becomes uninterested in feeding. Vital signs now are temperature 37.0°C
(98.6°F), pulse 150/min, and respirations 40/min. On physical examination, the neonate is alert and active. Lungs are clear. Chest and abdomen are normal. Anus is patent. The neonate
has passed only a small smear of stool since birth.
On day 2 of life, the neonate continues to have problems with feeding. On physical examination now, he appears alert and vigorous. Abdominal girth is increased 3 cm (1.2 in) since birth.
The abdomen is distended, but it remains soft to palpation. The neonate has not passed any stool today. A nasogastric tube is inserted and less than 10 mL of clear, nonbilious
secretions with small flecks of brown blood are disclosed. Which of the following is the most appropriate next step?
~ A) Administer ranitidine
B) Administer sucralfate therapy
C) Do lower gastrointestinal barium study
D) Obtain plain x-ray of the abdomen
E) Order upper endoscopy