A 36-HOUR-OLD male neonate developed rapid abdominal distention, poor feeding, lethargy, and jitteriness. The significant prenatal history included premature rupture of membranes for 1 week prior to delivery, but there was no evidence of chorioamnionitis, and results of a screening for group B Streptococcus were negative. The mother received intrapartum antibiotics because of premature rupture of membranes and received steroids to mature the fetal lung. The baby was delivered by emergency cesarean delivery because of fetal distress and persistent fetal tachycardia noted on intrapartum fetal monitoring. Apgar scores were 2 at 1 minute and 8 at 5 minutes. The infant received positive pressure ventilation for 3 minutes after birth. Physical examination revealed a 37-week, appropriate for gestational age male infant. The initial arterial blood gas at 30 minutes showed a pH of 7.39 and base excess of −4.8. The infant was started on formula feedings, which were tolerated well, and the first day's oral intake was 40 to 45 mL with each feeding. Meconium stools were passed 6 times after birth. At 36 hours, the neonate developed abdominal distention, lethargy, and poor feeding but did not vomit. He had tachycardia with normal peripheral perfusion, blood pressure, and oxygen saturation. The abdomen was markedly distended and tender with bulging of hernial orifices and absent bowel sounds. No abdominal discoloration, petechiae, or masses were present. An orogastric tube was inserted and yielded 10 mL of bilious drainage. Feedings were discontinued, and intravenous fluids and antibiotics were started. An abdominal supine radiograph (Figure 1) and horizontal beam decubitus radiograph (Figure 2) were obtained.
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