morphine and Vomiting

The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and harms, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of these procedures in healthy or meconium-stained neonates at birth. We systematically searched PubMed, Scopus, Embase, Ovid, and the Cochrane Library databases from inception to February 9, 2023. We included only RCTs assessing the outcomes of gastric suction or lavage in neonates at birth. We calculated risk ratio (RR) and weighted mean differences with 95% confidence intervals (CIs) using a random-effects model. The primary outcomes were gastrointestinal symptoms including vomiting, retching, feeding intolerance, and secondary aspiration. The secondary outcomes included time to initiation of breastfeeding and potential adverse procedure-related events. Twelve RCTs with a total of 4,122 neonates were analyzed. All the studies compared neonates who received gastric suction or lavage with those who received usual care. Gastrointestinal symptoms were significantly reduced in neonates receiving gastric suction or gastric lavage compared with the control group (RR, 0.75; 95% CI, 0.63-0.89). Gastric lavage was beneficial for infants with meconium-stained amniotic fluid (RR 0.71; 95% CI, 0.60-0.84), while gastric suction had no significant benefit in reducing gastrointestinal symptoms in infants without meconium-stained amniotic fluid (RR 0.91; 95% CI, 0.61-1.37). Our findings suggest that gastric suction or lavage may reduce gastrointestinal symptoms in neonates; however, these procedures may only benefit infants born with meconium-stained amniotic fluid. Vigorous newborns without meconium-stained amniotic fluid may not benefit from these procedures. Furthermore, gastric suction may lead to adverse outcomes such as apnea and bradycardia. Registration: This study was registered in the PROSPERO International prospective register of systematic reviews in health and social care (CRD42023247780).

Topics: Amniotic Fluid; Gastric Lavage; Humans; Infant; Infant, Newborn; Meconium; Stomach; Suction; Therapeutic Irrigation; Vomiting

To evaluate the efficacy and safety of gastric lavage (GL) in neonates born through meconium-stained liquor (MSL).. A systematic review of randomised controlled trials by searching databases MEDLINE (from 1966), EMBASE (from1980), CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar and proceedings of Pediatric Academic Society meetings (2002-2014).. Delivery room/Neonatal ward.. Neonates with gestation >34 weeks and birth weight ≥1800 g born through MSL.. Prophylactic GL versus no intervention before first feed.. Feeding intolerance, defined as inability to initiate/upgrade feeds due to problems such as retching, vomiting, regurgitation and gastric residuals.. A total of six studies (GL: 918, no GL: 966) were included in the review. Meta-analysis using fixed-effects model showed decreased incidence of feed intolerance following GL ((81/918 (8.8%) vs 114/966 (11.8%); risk ratio (RR): 0.71 (95% CI 0.55 to 0.93)). However, the results were not significant when random-effects model was used (RR: 0.78 (95% CI 0.55 to 1.09)). No significant adverse effects of GL were reported.. Routine GL immediately after birth may improve feed tolerance in neonates born through MSL. However, the evidence is limited, with probable small-study bias and high risk of bias in a number of the included studies. Well-designed studies with adequate sample size are essential to confirm these findings.

Topics: Amniotic Fluid; Feeding Behavior; Gastric Lavage; Humans; Infant, Newborn; Laryngopharyngeal Reflux; Meconium; Vomiting

Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies.. A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05).. Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension.. A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.

Topics: Adolescent; Age of Onset; Barium Sulfate; Biopsy; Child; Child, Preschool; Cohort Studies; Constipation; Diagnosis, Differential; Enema; Enterocolitis; Fecal Impaction; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Male; Meconium; Physical Examination; Rectum; Retrospective Studies; Unnecessary Procedures; Vomiting

Delivery-room gastric lavage reduces feeding intolerance and respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF).. To evaluate the effects of gastric lavage on exclusive breastfeeding and skin-to-skin contact in neonates delivered through MSAF.. Randomized controlled trial.. 110 late preterm and term neonates delivered through MSAF not requiring resuscitation beyond initial steps.. Participants randomized into gastric lavage (GL) (n=55) and no-GL (n=55) groups. The primary outcome was the rate of exclusive breastfeeding at 72±12 hours of life. Secondary outcomes were time to initiate breastfeeding and establish exclusive breastfeeding, rate of exclusive breastfeeding at discharge, time to initiate skin-to-skin contact and its duration, rates of respiratory distress, feeding intolerance, and the procedure-related complications of gastric lavage monitored by pulse oximetry and videography.. Both the groups were similar in baseline characteristics. 49 (89.1%) neonates in GL group could achieve exclusive breast-feeding at 72 hours compared to 48 (87.3%) in no-GL group [RR (95% CI) 1.02 (0.89-1.17); P=0.768]. Initiation of skin-to-skin contact was significantly delayed and the total duration was significantly less in GL group compared to no-GL group. No difference in respi-ratory distress and feeding intolerance was observed. Procedure-related complications included retching, vomiting, and mild desaturation.. Gastric lavage did not help to establish exclusive breastfeeding, delayed the initiation of skin-to-skin contact in delivery room and reduced its total duration. Moreover, the procedure of gastric lavage was associated with neonatal discomfort.

Topics: Amniotic Fluid; Breast Feeding; Delivery Rooms; Female; Gastric Lavage; Humans; Infant, Newborn; Meconium; Pregnancy; Respiratory Distress Syndrome; Vomiting

Neonates who swallow a considerable amount of maternal blood may exhibit vomiting and suckling disorder during the first few days of the postnatal period. Some clinicians treat these neonates with gastric lavage (GL) to prevent vomiting and the establishment of enteral feeding empirically, but there was no study assessing the effect of GL for neonates with coffee-ground emesis. We designed a multicenter randomized controlled trial to evaluate the efficacy and safety of GL in neonates with coffee-ground emesis. Vigorous neonates with birth weight ranging from 2500 g to 3999 g and gestational age between 37w0d and 41w6d who presented with coffee-ground emesis on more than twice and diagnosed as false melena, were divided into two groups using computerized randomization. We defined feeding intolerance (FI) as (1) ≥2 vomiting episodes in 4h or ≥3 episodes in 24h and/or (2) feeding failure on at least two occasions because of retching or poor sucking. Primary outcome is percentage of infants who present FI within 24 hours from admission. We also assessed the residual volumes, number of vomiting episodes, percentage of weight reduction at postnatal day 4, rates of body weight gain at 1 month of age, and peak serum total bilirubin value before discharge. To our knowledge, this is the first study to evaluate the safety and efficacy of GL for neonates with coffee-ground emesis. This trial is registered at UMIN Clinical Trials Registry as UMIN000026483.

Topics: Birth Weight; Female; Gastric Lavage; Humans; Infant, Newborn; Male; Meconium; Prospective Studies; Software; Vomiting

To compare the incidence of meconium aspiration syndrome and feed intolerance in infants born through meconium stained amniotic fluid with or without gastric lavage performed at birth.. Neonatal unit of a teaching hospital in New Delhi, India.. Parallel group unmasked randomized controlled trial.. 700 vigorous infants of gestational age ≥34 weeks from through meconium stained amniotic fluid.. Gastric lavage in the labor room with normal saline at 10 mL per kg body weight (n=350) or no gastric lavage (n=350). Meconiumcrit was measured and expressed as ≤30% and >30%.. Meconium aspiration syndrome, feed intolerance and procedure-related complications during 72 h of observation.. 5 (1.4%) infants in lavage group and 8 (2.2%) in no lavage group developed meconium aspiration syndrome (RR 0.63, 95% CI 0.21, 1.89). Feed intolerance was observed in 37 (10.5%) and 53 infants (15.1%) in lavage and no lavage groups, respectively (RR 0.70, 95% CI 0.47, 1.03). None of the infants in either group developed apnea, bradycardia or cyanosis during the procedure.. Gastric lavage performed in the labor room does not seem to reduce either meconium aspiration syndrome or feed intolerance in vigorous infants born through meconium stained amniotic fluid.

Topics: Amniotic Fluid; Female; Gastric Lavage; Humans; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Vomiting

Neonates born with meconium stained amniotic fluid (MSAF) can develop feed intolerance during first few days of post -natal period. A randomized controlled trial was conducted with the objectives of to find out the incidence of feed intolerance in vigorous neonates with MSAF who received gastric lavage (GL) as compared to those in whom it was not performed.. This was a randomized controlled trial on 500 neonates satisfying the inclusion criteria, 230 were allocated to GL and 270 to no lavage group through computer generated random numbers.. No significant difference in the incidence of vomiting was found between GL and no lavage group (8.7 % vs 11.5 %, p = 0.305). Feed intolerance had no relationship with gestational age, gender, birth weight and mode of delivery. No neonates of GL group developed any complications related to the procedure.. Thus, it may be concluded that gastric lavage is not required in neonates born with MSAF.

Topics: Amniotic Fluid; Birth Weight; Female; Gastric Lavage; Gestational Age; Humans; Infant, Newborn; Male; Meconium; Nausea; Vomiting

To compare reduction in incidence of feed intolerance in neonates born with meconium stained amniotic fluid (MSAF) by use of gastric lavage to those who did not receive lavage.. This Randomized controlled trial was conducted in all vigorous newborns delivered through MSAF, with birth weight ≥1800 g and gestation ≥34 wk. In the lavage group, gastric lavage with 10 ml/kg of normal saline was done.. Twelve neonates in the lavage group (n = 124) developed feed intolerance compared to 16 neonates in control group (n = 120), (p = .309; OR 0.69; 95%CI 0.27-1.58). No difference in any other morbidity was noted.. Gastric lavage in neonates with MSAF does not reduce feed intolerance, irrespective of thickness of MSAF and it confers no advantages.

Topics: Amniotic Fluid; Female; Gastric Lavage; Humans; Infant, Newborn; Male; Meconium; Nausea; Treatment Outcome; Vomiting

We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on to develop bilious emesis and abdominal distention as feeding continued over the next several hours. After a barium enema identified the distal obstruction, the pediatric surgical team used rectal irrigation to remove a large meconium plug, which mimicked the appearance of the descending colon on plain film, in a case of small left colon syndrome. Although intestinal obstruction in the newborn is rare, it is imperative that it is promptly diagnosed and treated appropriately to avoid negative outcomes; which, even in perhaps the mildest form of functional distal obstruction, meconium plug syndrome, can lead to an impressive clinical illness with risk of intestinal perforation and subsequent meconium peritonitis if the obstruction is not relieved.

Topics: Child; COVID-19; Cystic Fibrosis; Female; Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium; Vomiting

Topics: Humans; Infant, Newborn; Intestinal Obstruction; Meconium; Vomiting

Topics: Diagnosis, Differential; Female; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Meconium; Vomiting

Topics: Amniotic Fluid; Gastric Lavage; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Vomiting

Topics: Amniotic Fluid; Gastric Lavage; Humans; Infant; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Vomiting

Green-stained amniotic fluid does not always indicate that meconium was passed in utero.. We report the case of a 2280-g Hispanic preterm female born at 32 weeks of gestation with congenital jejunal atresia. The amniotic fluid was greenish stained; the initial impression was meconium-stained amniotic fluid. Postnatal findings revealed no meconium in her rectum. The content of her first stool appeared sticky and white.. In the absence of meconium in the rectum, the pediatrician should consider the possibility that the greenish amniotic fluid is not meconium stained, but rather stained with bile due to the fetus vomiting in utero secondary to intestinal obstruction.

Topics: Adult; Amniotic Fluid; Bile; Diagnosis, Differential; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intestinal Atresia; Intestinal Obstruction; Meconium; Pregnancy; Pregnancy Complications; Vomiting

Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Meconium; Pregnancy; Pregnancy Complications; Radiography, Abdominal; Vomiting

Topics: Amniotic Fluid; Female; Gastric Lavage; Humans; Male; Meconium; Nausea; Vomiting

A female neonate developed abdominal distension with vomiting. She was suffering from meconium ileus and cystic fibrosis.

Topics: Abdomen; Cystic Fibrosis; Female; Humans; Ileal Diseases; Ileum; Infant, Newborn; Intestinal Obstruction; Meconium; Vomiting

Bilious vomiting in newborns is an urgent condition that requires the immediate involvement of a team of pediatric surgeons and neonatologists for perioperative management. However, initial detection, evaluation and treatment are often performed by nurses, family physicians and general pediatricians. Bilious vomiting, with or without abdominal distention, is an initial sign of intestinal obstruction in newborns. A naso- or orogastric tube should be placed immediately to decompress the stomach. Physical examination should be followed by plain abdominal films. Dilated bowel loops and air-fluid levels suggest surgical obstruction. Contrast radiography may be required. Duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus and necrotizing enterocolitis are the most common causes of neonatal intestinal obstruction.

Topics: Duodenum; Enterocolitis, Necrotizing; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Meconium; Rotation; Vomiting

We identified 21 children (14 boys and seven girls) with long-segment Hirschsprung's disease defined as aganglionosis extending proximal to the ileocecal valve. Long-segment Hirschsprung's disease is difficult to diagnose and treat; symptoms may be mild, and diagnosis delayed. Abdominal distention and constipation or delayed passage of meconium are the most common symptoms. Radiologic studies are unreliable in establishing the diagnosis. The morbidity rate is high because of the high transition zone and short gut. The long-term outcome of patients after the standard Duhamel procedure is satisfactory, except with extremely high transition zones. Pull-through procedures should not be performed in the small infant, but should be delayed until patients are old enough to be continent.

Topics: Abdomen; Constipation; Female; Follow-Up Studies; Hirschsprung Disease; Humans; Ileal Diseases; Ileocecal Valve; Ileostomy; Infant; Infant, Newborn; Male; Meconium; Survival Rate; Vomiting

Three babies said to have had 'meconium stained liquor' were subsequently found never to have passed meconium. The green discoloured liquor was the result of bilious vomiting in utero secondary to intestinal obstruction.

Topics: Bile; Diagnosis, Differential; Female; Fetal Distress; Humans; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Pregnancy; Vomiting

Topics: Bile; Humans; Infant, Newborn; Intestinal Obstruction; Meconium; Vomiting

From June 1980 to September 1984, forty-five newborns (weight greater than or equal to 2000 g), initially presumed normal, were seen with bilious vomiting in the first 72 hours and were prospectively followed up. Nine (20%) required surgical intervention, five (11%) had nonsurgical obstruction such as meconium plug or left microcolon, and the remaining 31 (69%) had idiopathic bilious vomiting. Infants with idiopathic bilious vomiting had a benign transient course and resumed feedings by 1 week of age; 30 of the 31 had normal or nonspecific findings on initial plain abdominal roentgenogram. Specific findings on the initial plain abdominal roentgenogram were noted in five infants, and four (80%) of these had a lesion requiring surgical intervention; 56% (5/9) of neonates with surgical lesions had normal or nonspecific findings on the plain abdominal roentgenograms. None developed bowel ischemia or midgut infarction secondary to a volvulus as they were identified by contrast studies shortly after the initial episode of bilious vomiting. Although the majority of "normal" neonates with bilious vomiting do not have a surgical lesion, this study indicates that 56% of surgical cases will be missed if contrast studies are not done.

Topics: Age Factors; Bile; Colon; Contrast Media; Female; Gastric Lavage; Gastrointestinal Diseases; Humans; Infant, Newborn; Intestinal Obstruction; Intubation, Gastrointestinal; Male; Meconium; Radiography, Abdominal; Vomiting

Topics: Acute Disease; Antifungal Agents; Candida albicans; Candidiasis; Cystic Fibrosis; Flucytosine; Fungemia; Humans; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Jaundice; Male; Meconium; Rare Diseases; Vomiting

Topics: Calcinosis; Constipation; Female; Fetal Diseases; Gastrointestinal Motility; Humans; Infant; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Radiography, Abdominal; Time Factors; Tissue Adhesions; Vomiting

Topics: Abnormalities, Multiple; Age Factors; Bile; Child; Child, Preschool; Down Syndrome; Duodenal Obstruction; Duodenum; Esophageal Atresia; Female; Humans; Infant; Infant, Newborn; Meconium; Polyhydramnios; Pregnancy; Vomiting

Topics: Amniotic Fluid; Bile; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Meconium; Polyhydramnios; Pregnancy; Vomiting

Topics: Animals; Bile Ducts; Dehydration; Duodenal Obstruction; Duodenum; Gastrointestinal Motility; Humans; Infant, Newborn; Intestinal Atresia; Meconium; Pancreas; Rabbits; Radiography; Thalidomide; Tracheoesophageal Fistula; Vomiting

Topics: Anemia; Body Weight; Chloramphenicol; Chlortetracycline; Cough; Cystic Fibrosis; Diabetes Mellitus, Type 1; Diet Therapy; Feces; Humans; Hunger; Hypoproteinemia; Infant; Infant, Newborn; Intestinal Obstruction; Meconium; Pancreatic Juice; Pancreatin; Physical Therapy Modalities; Prognosis; Rectal Prolapse; Sweat; Tooth Discoloration; Vomiting

Topics: Duodenal Obstruction; Humans; Infant; Intestinal Obstruction; Jejunum; Meconium; Megacolon; Posture; Radiography; Vomiting

Because the clinical appearance of newborn infants having intestinal obstruction is disarmingly normal, vomiting is reason for immediate search for the cause. To this end the character of stools and meconium that are passed should be carefully observed, lest valuable time elapse before correct diagnosis is made. In three cases of volvulus observed by the authors, there was moderate to pronounced distention of the abdomen at birth-a sign which may be helpful in diagnosis. Roentgenograms are the most helpful diagnostic aid. Since the roentgenographic appearance of the normal infant abdomen differs from that of the adult, interpretations should be made with that in mind. In this connection the absence of gas shadows is significant. Although there are dangers in the use of barium in infants, early diagnosis is so important that use of the substance is justifiable if it will help in correct appraisal. The treatment is always surgical, and the procedure of choice is primary anastomosis. Proper preoperative and postoperative care and treatment, including maintenance of fluid and electrolyte balance and blood volume, are of great importance.

Topics: Adult; Disease; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Volvulus; Intestines; Meconium; Vomiting