A 3-Day-Old Boy Is Seen in the Nursery Due to Vomiting

question 480

Multiple Choice

A 3-day-old boy is seen in the nursery due to vomiting.  He has had 2 episodes of nonprojectile vomiting of green fluid and has developed abdominal distension over the last hour.  The patient is breastfed and initially nursed every 2 hours but is now nursing less frequently.  The infant passed a small amount of meconium immediately after delivery but has passed no other stool.  He is voiding adequately.  The patient was delivered vaginally at 38 weeks gestation without complications.  Apgars were 8 and 9 at 1 and 5 minutes, respectively.  Temperature is 36.7 C (98 F) .  On examination, the infant is asleep but easily roused.  The anterior fontanelle is open and flat, and the mucous membranes are moist.  Cardiac examination is normal.  The lungs are clear to auscultation bilaterally.  The abdomen is distended with hypoactive bowel sounds.  The liver and spleen are not palpable.  Abdominal x-ray findings include dilated, gas-filled loops of small bowel; absent air-fluid levels; and a "ground-glass" mass in the right side of the abdomen.  Further history-taking should focus on which of the following factors?

• A)Family history of congenital cataracts
• B)Family history of recurrent sinus infections
• C)In utero opioid exposure
• D)Maternal age ≥35
• E)Maternal macrolide use during pregnancy

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