“Dr. Cohen, can you come check on a baby?”
When I got the call, I was busy arranging for the transport of a sick teenager from the community hospital where I work to an intensive care unit at a nearby children’s hospital. A maternity ward nurse wanted me to examine an infant who had not had a bowel movement in the 40 hours since his birth. Most healthy newborns have their first bowel movement within 24 hours; if 48 hours go by without a stool, doctors worry about a number of possible problems, including intestinal obstruction. I asked if the baby had a distended abdomen or had been vomiting, and the nurse said no. I told her to order an abdominal X-ray and said I’d be there soon. The infant had looked healthy when I first examined him the day before. His anus was not blocked, and there had been no unusual masses or abdominal distension.
Just as I was finishing up with the other patient, the radiologist called to say that the baby’s X-ray showed no sign of obstruction. Nor was there any sign of free air in the abdomen, which would have signaled a rupture of the intestine, a potentially catastrophic condition. The intestinal tract appeared intact all the way through. As I approached the nursery, I decided that if the baby looked OK, I would wait a few more hours before ordering any additional tests.
