Case 3: Term Infant with Delayed Meconium Passage and Bilious Emesis

Presentation

An infant boy is born via emergency cesarean section because of cord prolapse. The mother is a 33-year-old, gravida 4, para 2 Black woman. Maternal history is significant for obesity (body mass index >30 kg/m²) with a normal result on 1-hour glucose tolerance test. The pregnancy course is unremarkable. The infant is born at 37 2/7 weeks with a birthweight of 2,950 g (20th percentile). Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The infant grunts after delivery, with an oxygen saturation of 99% but no respiratory distress, which resolves shortly after birth.

At 24 hours of age, the family reports that the infant had 2 episodes of bilious emesis in the setting of delayed passage of meconium. The infant had breastfed 3 times and urinated 4 times. Physical examination findings include decreased bowel sounds, soft and nontender but distended abdomen, no hepatosplenomegaly, and mild hypotonia. Because of persistent bilious emesis, the infant is transferred to the NICU for nasogastric tube placement, bowel rest, and intravenous fluids. An upper gastrointestinal series is performed with abdominal radiography and contrast enema (Figs 1 and 2).