Frequent vomiting in new-born

Day 6 old new-born was brought with frequent episodes of vomiting. Antenatal sonograpghy scans were normal, even anomaly scan was normal. Usually the vomiting episodes post feeding of curd like content or even small quantity of milk is normal at this age and that too till 4-6 months of age. In this case baby vomited in consulting chamber itself, and this time baby was fed around 1.5-2 hrs before vomiting. This baby was given antiemetics for vomiting. Next day again the child was in consulting chamber with same complaints, not responding to medicine and this time it was too projectile, which is never normal at any age. Since baby had passed motions regularly and normally and till now feeding also well, it was surprising to see such vomiting. We admitted the child and did basic workup, blood investigations came normal, but Chest X-ray showed air fluid levels; we got USG Thorax done and found instestines and spleen in thorax, it was DIAPHRAGMATIC HERNIA. Usually it presents with difficulty in breathing in new-born age group as it compromises lung volume and gastrointestinal symptoms at later age group in milder cases, here it was reverse. Thankfully the vomiting happened in consulting chamber which made us realized that it is not normal regurgitation vomiting. Child got operated with pediatric surgeon at day 7 of age and now absolutely normal on follow-up. DISCUSSION: History is key to diagnosis; here we had history suggestive of abnormal vomiting like late after feeding, projectile, not responding to medicine which made us think this is not normal regurgitation.

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