Withholding feeds is a significant
decision for infants in the NICU, particularly extremely low birth weight infants.
An audit of practice in NICU identified that withholding feeds was a significant
contributor to poor growth in infants.1
and nutrients can be more safely and more easily delivered by enteral feeds
than by intravenous nutrition, without increased cost and increased risks of
However, some infants with
feed intolerance may have significant intra-abdominal or other problems.
Colour Chart for Assessing Aspirate Colour
Note that colostrum may
appear yellow in colour.
Some infants will have
bilious aspirates that are bright yellow in colour in the initial phases.
of Bilious Aspirates or Vomiting
Feed intolerance is common
in preterm infants. However, it is less common in term infants. In term infants,
especially those with bile-stained vomiting or bilious aspirates, gastrointestinal
pathology needs to be investigated and early surgical consultation should be
Causes of bilious aspirates/vomiting
include (but are not limited to):
Proximal bowel obstruction
(yet distal to the duodenum).
It is particularly
important to consider intestinal malrotation.2
Radiographs and abdominal examination may be normal in infants with malrotation,
particularly in the early stage of the condition or if the obstruction
is intermittent. If malrotation is considered a possible diagnosis, an
upper GI contrast study should be considered. A recent report of
infants presenting to a surgical NICU with bilious vomiting demonstrated
that 22% had an intestinal malrotation.3
Other bowel obstruction
may result in bilious vomiting or aspirates.
An abdominal radiograph
may indicate intra-abdominal pathology, with air-fluid levels
If sepsis is considered
likely but an intra-abdominal source is not thought to be the primary
source, then the
antibiotics of first choice are amikacin and
should be considered early.
Reintroduction of feeding
will depend on the underlying condition and the individual preferences
of the supervising specialist.
BE, Bloomfield FH. An audit of feeding practices in babies <1200g or 30
weeks gestation during the first month of life. Perinatal Society of Australia and New Zealand
9th Annual Congress, Adelaide, 2005. A42.
PJ. Disorders of intestinal rotation and fixation ("malrotation").
Pediatr Radiol 2004;34:837-51.
JK, Mills JF. Neonatal bilious emesis: when does it matter? Perinatal Society of Australia and New Zealand
9th Annual Congress, Adelaide, 2005. P61.