A 2-day-old male newborn is brought to the emergency department by his mother because of irritability and vomiting for two hours. During this period, he has vomited dark green emesis three times. He has not yet passed stool. He was born via normal spontaneous vaginal delivery at 39 weeks gestation to a primigravid mother. The mother has breastfed the newborn every two hours. The abdomen is distended. Digital rectal examination shows no abnormalities. An x-ray of the abdomen with contrast shows dilated small bowel loops, a microcolon, a mixture of gas and meconium located in the right lower quadrant. Contrast enema fails to relieve the obstruction, and the patient is taken for emergency laparotomy, which shows an inspissated, green fecal mass obstructing the distal ileum. The infant recovers from the surgery uneventfully. Which of the following will be the most likely cause of mortality in this patient?

Question

A 2-day-old male newborn is brought to the emergency department by his mother because of irritability and vomiting for two hours. During this period, he has vomited dark green emesis three times. He has not yet passed stool. He was born via normal spontaneous vaginal delivery at 39 weeks gestation to a primigravid mother. The mother has breastfed the newborn every two hours. The abdomen is distended. Digital rectal examination shows no abnormalities. An x-ray of the abdomen with contrast shows dilated small bowel loops, a microcolon, a mixture of gas and meconium located in the right lower quadrant. Contrast enema fails to relieve the obstruction, and the patient is taken for emergency laparotomy, which shows an inspissated, green fecal mass obstructing the distal ileum.  The infant recovers from the surgery uneventfully.  Which of the following will be the most likely cause of mortality in this patient?

Quizplus · Accepted Answer

Eductional Objective: Meconium ileus is a distal small bowel obstruction due to abnormally dehydrated meconium in a patient with cystic fibrosis (CF).  Persistent, treatment-resistant infectious pneumonias, bronchiectasis, and cor pulmonale account for most deaths due to CF.

A 2-Day-Old Male Newborn Is Brought to the Emergency Department