VOMITING IN NEWBORN

Common symptom in infant and children.

• Vomiting: forceful expulsion of gastric contents through the mouth and is usually accompanied by vigorous contractions of abdominal muscles and descent of diaphragm.
• Regurgitation: non- forceful, expulsion of food and secretions from the esophagus or stomach through the mouth not accompanied by nausea or forceful contractions.
• Nausea: feeling of inclination to vomit
• Retching: effort to vomit, short of expulsion of gastric contents
• Rumination: habit of bringing up semi digested food and chewing it again

Majority of neonates vomit without a pathological cause. Vomiting become pathological only if

• it is bilious
• hemorrhagic
• nonbilious but projectile and persistent
• associated with failure to thrive

• Congenital anomalies of GIT, Esophageal atresia, GERD, duodenal stenosis, pyloric stenosis
• CNS causes: intracranial bleed, meningitis
• Cardiac causes: myocarditis
• Inborn errors of metabolism
• Septicaemia
• Endocrine disorders- congenital adrenal hyperplasia
• Miscellaneous : ingestion of amniotic fluid, maternal medication

• Vomiting on the first day of life- due to gastritis (as a result of amniotic fluid ingestion)
• Regurgitation following feeds: improper techniques of feeding and aerophagy
• Persistent, projectile, and bile stained vomiting- suggest intestinal obstruction

Growth assessment

• Failure to thrive will be seen in neonates with persistent vomiting

Dysmorphic facies

• Congenital intestinal obstruction is often associated in neonates with chromosomal aberrations Eg: duodenal atresia in downs syndrome

Bulging fontanel

• Points towards raised intracranial tensions as in meningitis, hydrocephalus, intracranial haemorrhage

Jaundice

• due to liver disorders

Cataract

• Examine for cataract, which appears in galactosemia after 2 to 6 weeks of age

Umbilical cord

• Inspect the umbilical cord for sepsis

Abdomen

• Abdominal distension 
• Palpate for any lump
• Palpate for hepatosplenomegaly

Sepsis screen: 

• CBC counts: leukopenia less than 5000/mm3
• Culture of blood, urine, CSF, swabs from septic umbilical cord
• Skiagram of abdomen
• USG abdomen
• Serum electrolytes, pH
• X-ray abdomen the erect posture. A single gastric air fluid level indicates pyloric obstruction Double bubble indicates duodenal obstruction. Triple bubble indicates jejunal obstruction Many air fluid levels indicate ileal or colonic obstruction So depending on the number of air fluid levels, one can ea diagnose the level of obstruction.
• If an upper GIT obstruction is suspected, a barium meal X- is indicated. For lower GIT obstruction, barium enema X-ray is choice.

• Surgical correction in case of a structural anomaly
• After proper evaluation and needed structural corrections

Ayurvedic Treatment

Check for any stanyadushti

• If there is any signs of stanyadushti - do stanyasodhana
• Strict dietetic guidelines for mother
• Use of laghu, ushna ahara
• Avoid excess amla, katu
• Educate proper feeding methods
• Mandatory burping after each feed

Internal medications

Vataanulomana in mother

• Dhanwantara gutika: 1 tab tds
• Gandharvahasthadi kashaya- 1 ½ tsp powder boiled in 1 ½ glass water and given thrice daily half-hour before food

 Amapachana and agnideepana   in mother

• Ashta choorna: 1 tsp tds with honey
• Shadanga kashaya: as toya or seetha kashaya
• Abhayarishta, Mustarishta: 15 ml tds after food