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Intestinal Obstruction in the Newborn Medication

  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Mar 17, 2016
 

Medication Summary

The goals of pharmacotherapy are to facilitate evacuation, reduce morbidity, and prevent complications.

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Laxatives, Osmotic

Class Summary

An enema with a high osmolality solution should be performed to facilitate evacuation.

Diatrizoate enema (Hypaque Sodium)

 

An enema with a high osmolality solution should be performed to facilitate evacuation. Diatrizoate enema has the advantage of acting as an osmotic laxative, which may aid in the evacuation of the colonic contents. Contrast radiography is diagnostic, and the diatrizoate enema has remarkable efficacy in loosening the sticky meconium and facilitating evacuation (>50% success rate).

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Prokinetic Agents

Class Summary

Two promotility pharmacologic agents are useful: metoclopramide and erythromycin. Randomized controlled trials of these agents have produced variable results compared with placebo, and each has adverse effects that may render them unacceptable. Many clinicians justify the use of these medications with anecdotal reports or by personal experience, rather than according to “evidence-based medicine.”

Metoclopramide (Metozolv)

 

Metoclopramide is a dopamine antagonist that stimulates acetylcholine release in the myenteric plexus. Metoclopramide enhances gastrointestinal motility and accelerates gastric emptying time.

Erythromycin (E.E.S., Erythrocin)

 

Erythromycin has a prokinetic effect on the GI tract at a dose that is about a quarter less of the antibiotic dose, which may be mediated by stimulating cholinergic neurons. High doses may directly stimulate a motilin muscular receptor in the GI tract.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Vancomycin

 

Vancomycin is a potent antibiotic directed against gram-positive organisms; in addition, it is active against Enterococcus species. It is useful in the treatment of gram-positive septicemia and soft-tissue infections. It is indicated for patients who are allergic to penicillin or cephalosporin, or whose infections have not responded to these agents. Creatinine clearance may be used to adjust the dosage in patients with renal impairment.

Metronidazole (Flagyl)

 

Metronidazole causes a chemical reduction reaction in anaerobic bacteria and sensitive protozoa. It is readily absorbed and permeates all tissues, including cerebrospinal fluid (CSF), breast milk, and alveolar bone. It is metabolized and excreted in the liver and kidneys. 

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Contributor Information and Disclosures
Author

James G Glasser, MD, MA, FACS Associate Professor of Surgery and Pediatrics, University of South Alabama College of Medicine; Attending Staff, USA Children's and Women's Hospital

James G Glasser, MD, MA, FACS is a member of the following medical societies: Christian Medical and Dental Associations, American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Shelley C Springer, JD, MD, MSc, MBA, FAAP Professor, University of Medicine and Health Sciences, St Kitts, West Indies; Clinical Instructor, Department of Pediatrics, University of Vermont College of Medicine; Clinical Instructor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

Shelley C Springer, JD, MD, MSc, MBA, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

William T Adamson, MD Division Chief of Pediatric Surgery, Associate Professor of Surgery, University of North Carolina at Chapel Hill School of Medicine; Surgeon-in-Chief, North Carolina Children's Hospital

William T Adamson, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Society of Laparoendoscopic Surgeons, and Wilderness Medical Society

Disclosure: Nothing to disclose.

David A Clark, MD Chairman, Professor, Department of Pediatrics, Albany Medical College

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Andre Hebra, MD Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of these medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Esophageal atresia. Intraoperative view of proximal esophageal atresia and distal tracheoesophageal fistula.
Malrotation.
Malrotation with volvulus of proximal small intestine coiled around the superior mesenteric vessels.
Duodenal atresia. Note the double-bubble sign and narrowing in the second portion of the duodenum. There is partial obstruction, the duodenum does cross the midline, and there is no twist.
Jejunal atresia. Note the sharp transition between the proximal dilated jejunum and the distal unused intestine at the point of the atresia.
Jejunal atresia. Ischemic compromise of the proximal segment is noted.
Meconium plug. Contrast enema reveals the dilated colon proximal to the meconium plug; the enema may be therapeutic to relieve the obstruction.
Imperforate anus.
A sample algorithm for the diagnosis of neonatal intestinal obstruction.
Pyloric stenosis. Intraoperative view of the hypertrophied pylorus prior to a pyloromyotomy incision.
Intraoperative view showing an intraluminal web, which will be excised; the longitudinal enterotomy will then be closed transversely.
Discontinued intestinal atresia. Intraoperative view of the bulbous obstructed proximal bowel and the diminutive distal intestine.
Meconium ileus. Intraluminal intestinal obstruction from thick, tenaceous meconium.
Colonic atresia. This huge, dilated colon will never function satisfactorily and therefore must be resected.
Midgut volvulus. Intraoperative view of the twisting of the terminal ileum and cecum around the base of the mesentery.
Omphalomesenteric duct (Meckel diverticulum) attached to the umbilicus.
Colon pull-through for Hirschsprung disease.
Midgut volvulus. Necrosis of the midgut is the the most feared complication of malrotation/volvulus.
Incarcerated inguinal hernia. Intestinal obstruction caused by an incarcerated inguinal hernia; the viability of the testicle is also at risk.
Malrotation volvulus. Note the partial duodenal obstruction. The distal duodenum does not cross the midline (over the vertebral column) and the "curly Q" twist.
Gastrografin enema. Note the tiny, unused colon and the dilated (by swallowed air) proximal, obstructed intestine.
Midgut volvulus. The bowel is eviscerated and the entire midgut is twisted counterclockwise, effecting reduction of the volvulus.
The midgut volvulus is reduced.
The peritoneal bands (Ladd bands) tethering the duodenum to the colon are divided, exposing the superior mesenteric vessels.
Complicated meconium ileus. Volvulus of the dilated, meconium-ladened loop of intestine.
 
 
 
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