Case 4: Delayed Passage of Meconium, Abdominal Distention, and Emesis in a 2-day-old Girl

1. Leslie Mataya, MD* 2. Poj Lysouvakon, MD* 1. *Department of Pediatrics, University of Chicago Medical Center, Chicago, IL A full-term newborn is delivered via normal spontaneous vaginal delivery to a 38-year-old gravida 5, now para 5005 mother. The mother underwent elective induction of labor for preeclampsia without severe features. The mother received adequate prenatal care, and serologic tests were negative apart from group B Streptococcus colonization, for which she received adequate intrapartum antibiotic prophylaxis. The labor and delivery course was uneventful, and Apgar scores were 9 and 9 at 1 and 5 minutes, respectively, with suction, drying, and stimulation. Birthweight was 3,270 g (appropriate for gestational age); length, 52 cm; and head circumference, 33 cm. For the first 24 hours after delivery, the infant took the bottle well, with minimal regurgitation. The abdomen was soft and nondistended. Now, on postnatal day 2, her intake by mouth is decreased, her abdomen has become firm and distended, and she is having more large-volume emesis that is nonbloody and nonbilious. She has also failed to pass meconium for more than 24 hours. Abdominal radiographs are obtained that show multiple dilated loops of bowel with absence of distal air, …