Neonatal Nuggets Part 2: tummy troubles

A 4-week old baby presents with a seven day history of vomiting small amounts after feeds. She is breast-fed every three hours and her parents describe it as non-projectile and milk coloured. She has plenty of wet and dirty nappies and is thriving. The child is otherwise well, asymptomatic and there is no abnormality on examination. Her weight is 3.5kg.
What is the most appropriate management?

The same infant represents a week later as she is now experiencing marked distress associated with frequent regurgitation that remains non-projectile and milk coloured. In between the episodes she is well, thriving and has plenty of wet and dirty nappies. Her mother has sought advice from a breast feeding advisor who is happy with her technique. The child is otherwise well, asymptomatic and there is no abnormality on examination. Her weight is 3.6kg.
What is the most appropriate management?

A 4-week old baby presents with a seven day history of vomiting after feeds. She is bottle fed four ounces every three hours and her parents describe it as non-projectile and milk coloured. She has plenty of wet and dirty nappies and is thriving. The child is otherwise well, asymptomatic and there is no abnormality on examination. Her weight is 3.5kg.
What is the most appropriate management?

A 2-day old baby presents with a single episode of bright yellow vomit. She is breast-fed every two hours, has passed meconium and has wet nappies. The child is otherwise well, asymptomatic and there is no abnormality on examination. Her current weight is 3.3kg compared to a birth weight of 3.5kg as documented in her red book.
What is the most appropriate management?

A 2-week old baby presents with a single episode of blood-stained vomit. She is breast-fed every two hours, has passed meconium and has wet nappies. The child is otherwise well, asymptomatic and there is no abnormality on examination. She has regained her birth weight and had intramuscular vitamin K at birth.
What is the most appropriate management?

A 6-week old baby presents with episodes of distress during the evenings and night for over a week. The episodes last for hours at a time and the family are sleep deprived. They are associated with bringing up legs, turning red in the face and clenching fists. In between the episodes she is well, thriving and has plenty of wet and dirty nappies. There are no obvious episodes of regurgitation and her stools are soft.
What is the most likely diagnosis?

A 6-week old baby presents with episodes of distress whilst she is trying to open her bowels. They are associated with bringing up legs, turning red in the face and clenching fists. In between the episodes she is well, thriving and has plenty of wet and dirty nappies. There are no obvious episodes of regurgitation and her stools are soft.
What is the most likely diagnosis?

A 3-day old baby presents with an episode of blood in the nappy. She has plenty of wet and dirty nappies and is thriving. The child is otherwise well, asymptomatic and there is no abnormality on examination. She received intramuscular vitamin K soon after birth. When you examine the nappy a pink-orange discolouration is noted.
What is the most likely diagnosis?

A 3-day old baby presents with an episode of blood in the nappy. She has plenty of wet and dirty nappies and is thriving. The child is otherwise well, asymptomatic and there is no abnormality on examination. She received intramuscular vitamin K soon after birth. When you examine the nappy a small amount of fresh blood is noted that on subsequent examination it appears to be arising from the vulva.
What is the most likely diagnosis?

A 4-week old baby presents with recurrent episodes of “diarrhoea”. Her parents report 3-4 dirty nappies a day that are never formed (unlike their friends baby who is bottle fed) and appeared shortly after her “black tarry poos” ended. The child is otherwise well, thriving and there is no abnormality on examination. When you examine the nappy there’s significant liquid stool with solid bright yellow material on top that is “seedy” in places.
What is the most likely diagnosis?