21day infant w/ Post-Operative Gastroparesis, J-Tube, Cisapride

[Dana-Fecher]

  Hannah was diagnosed with partial Situs Inversis (a reversal of the stomach and displacement of the liver) two months prior to birth. She was born healthy in all visible respects with an initial APGAR of 9 and subsequent APGAR of 10. We transported her immediately to NICU to test her for heart and digestive disorders.
  After 24 hours, all ultrasounds, x-rays and electrocardiograms resulted negative. She had, however, vomited several times. We initiated an Upper GI which revealed a malrotation of the bowel. An emergency Ladd's procedure was initiated and was successful. No detrioration of the stomach or bowel was noted during the operation.
  Hannah currently has recovered all functionality of her digestive system except the stomach(gastroparesis). She has a J-tube which is working well. She is on Cisapride (1.6ml 3times/day) and Zantac. Reglan was used for 24 hours with no effect and quickly discontinued in favor of Cisapride.
  Hannah's weight has increased from 7lbs 8oz to 8lbs 3oz and she is off all pain medication. Her vomiting of bile has ceased over the last few days. We took this as a positive sign and initiated a gastric emptying study. The results showed no real emptying of the stomach over the course of an half-hour (everything else worked well). Yet she did not vomit the 40ml of barrium given her and passed it through in 3 stages over the following 20 hours.
  Our current direction is to continue the J-tube and prokenitic drug for 2 months and look for the stomach to "wake-up". Is this a real possibility? What is her prognosis at this point. We feed her by machine for 1.5 hours every three hours. We've just started feeding her 10-15ml of formula orally at each feeding and she keeps it down. Yet it is such a small amount. Plus, I saw her stomach seemingly paralyzed just two days ago and I can't account for her marginally improved condition (less abdominal pain and no vomiting). Note: Her stomach is not distended and has not been since birth.
  Any comments would be greatly appreciated. I am having great difficulty finding much information on my daughter's specific condition and prognosis.
  Thank you in advance,
  Dana Fecher
________________
Dear Dana,
The GI Forum no longer has the services of a pediatric gastroenterologist.  I suggest that you respost your e-mail to the Maternal-Child Forum.
HFHSM.D.-rf