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An interesting cause of neonatal feed intolerance
  1. David Sinton1,
  2. Pamela Dawson1,
  3. Thillagavathie Pillay2,3
  1. 1School of Paediatrics, West Midlands Deanery, West Midlands, UK
  2. 2Neonatal Department, Russells Hall Hospital, Dudley, West Midlands, UK
  3. 3Neonatal Department, New Cross Hospital, Wolverhampton, UK
  1. Correspondence to Dr David Sinton, davidsinton{at}

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Growth restricted twins were born at 29+2 weeks gestation. They were managed with empirical antibiotics, surfactant therapy and respiratory support. Both received total parenteral nutrition (TPN) until fully enterally fed.

By day 5 of life, they were commenced on expressed breast milk, using a feeding protocol standardised for babies at high risk of complications. Both had large gastric aspirates and commenced prokinetic erythromicin. They were fully fed by day 15. On day 16, feeds were increased for failure to gain weight. Gaviscon was added due to concerns regarding gastro-oesophageal reflux and phosphate supplements for rising alkaline phosphatase.

By day 18, twin 1 developed desaturations. Concomitantly, difficulty in prefeed aspiration of the nasogastric tube (NGT) and a full, tender epigastrium was noted. As part of a partial septic …

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