Non bilious Vomiting and Progressive Feeding Intolerance in a Term Neonate: not the usual suspect

Non bilious Vomiting and Progressive Feeding Intolerance in a Term Neonate: not the usual suspect | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Non bilious Vomiting and Progressive Feeding Intolerance in a Term Neonate: not the usual suspect Enrico Perre, Laura Marone, Domenico Noviello, Dolores Ferrara, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8823129/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A term male newborn with a prenatal history of polyhydramnios developed progressive feeding intolerance and repeated non-bilious vomiting within the first 24 hours of life, despite normal passage of meconium. Physical examination revealed mild abdominal distension without tenderness. Significant gastric aspirate was obtained via nasogastric tube. Imaging demonstrated findings consistent with gastric outlet obstruction. The diagnosis of congenital pyloric atresia , a rare cause of neonatal non-bilious vomiting, was established. Prompt surgical intervention following stabilization is required to prevent complications and ensure favorable outcomes. Figures Figure 1 QUESTION A 24-hour-old male newborn with a history of polyhydramnios since the second trimester was delivered at term (41 + 1 weeks) via eutocic vaginal delivery, with a birth weight of 3,000 grams. Infant regularly urinated and passed meconium within the first hours of life. However, within 24 hours he developed progressive feeding intolerance; attempts at breastfeeding resulted in repeated, non-bilious vomiting and increasing irritability. The abdomen appeared mildly distended, but there was no overt tenderness or palpable mass. Despite normal passage of meconium, the infant exhibited poor feeding and mild dehydration. A nasogastric tube was placed, yielding significant gastric aspirate (> 30 mL), and abdominal distension worsened. An abdominal ultrasound and intestinal transit X-ray were performed (Fig. 1 ). Based on the case presentation and what you see in Fig. 1 , what is your diagnosis and how would you manage this patient? (Answer given below). ANSWER Congenital pyloric atresia (CPA) is a rare cause of neonatal gastric outlet obstruction, typically presenting within the first days of life. It is characterized by complete or partial interruption of the pyloric canal and may occur as an isolated anomaly or in association with other congenital conditions, such as epidermolysis bullosa [ 1 , 2 ]. Typical clinical features include early-onset non-bilious vomiting, progressive feeding intolerance, and signs of dehydration, as observed in this case [ 3 – 5 ]. Prenatal polyhydramnios represents an important diagnostic clue for proximal gastrointestinal obstruction. It results from impaired fetal swallowing and is commonly associated with conditions such as congenital pyloric atresia, duodenal atresia, and esophageal atresia. Prenatal ultrasound may also reveal an enlarged fetal stomach, further supporting the suspicion of gastric outlet obstruction [ 6 – 8 ]. Diagnosis first relies on imaging, as abdominal ultrasound may reveal a markedly distended stomach with no distal air, eventually an atresic pyloric end without continuity into the duodenum, as in our case [ 6 , 9 ]. Abdominal X-ray typically demonstrates a "single bubble" sign—air confined to the stomach with absence of distal gas due to its failure to pass through the pylorus, resulting in the absence of normal intestinal gas pattern [ 9 ]. The differential diagnosis of a single bubble includes hypertrophic pyloric stenosis and a gastric duplication cyst. However, unlike gastric or pyloric atresia hypertrophic pyloric stenosis shows some gas visible distally due to partial, not complete, obstruction. Upper gastrointestinal contrast studies with a contrast agent further confirm the diagnosis by showing failure of contrast to pass beyond the pylorus [ 6 , 10 ]. Within differential diagnosis, hypertrophic pyloric stenosis is unlikely in the immediate neonatal period, as it typically presents after the second to third week of life. Duodenal atresia is usually associated with a “double-bubble” sign on abdominal radiography and often presents with earlier and more severe abdominal distension. Malrotation with volvulus may present with vomiting and abdominal distension; however, it more commonly causes bilious emesis and is often associated with acute clinical deterioration [ 7 , 9 , 10 ]. Initial management consists of prompt gastric decompression with a nasogastric tube, correction of fluid and electrolyte imbalances, and stabilization of the neonate prior to surgery. Definitive treatment of congenital pyloric atresia is surgical, with procedure depending on the anatomical subtype. Minimally invasive laparoscopic approaches have been successfully reported and may offer advantages in select cases. In our patient, a laparoscopic surgical approach was successfully performed, with an uneventful postoperative course and good feeding tolerance at follow-up [ 5 , 10 ]. Declarations I confirm that the legal guardian consented to participate and publish the clinical case. Ethics Approval Statement This case report describes the clinical course of a single patient using de-identified data and images. Ethics approval is not required for single anonymized case reports according to our institutional policies: The Central Emilia Wide Area Ethical Committee of the Emilia-Romagna Region (CE-AVEC), located at the IRCCS Azienda Ospedaliero - Universitaria di Bologna, Policlinico di S. Orsola, established by regional resolutions n. 923 of 05/06/2023 and n.1028 of 19/06/2023. References Sakamoto N, Masumoto K, Aoyama T, Shirane K, Homma Y (2024) Pyloric Atresia in a Neonate With Epidermolysis Bullosa: A Case Report. Clin Case Rep 12(12):e9685 Pan P (2021) Congenital Pyloric Atresia and Epidermolysis Bullosa: Report of a Rare Association. J Indian Assoc Pediatr Surg 26(4):256 Huerta CT, Sundin A, Gilna GP, Saberi RA, Ramsey WA, O’Neil CF et al (2021) Laparoscopic-assisted Open Pyloroduodenostomy Repair of Pyloric Atresia in an Infant: A Rare Congenital Anomaly. Surg Laparosc Endosc Percutan Tech. 9(1):150–152 Morton Z, Stickler E, Thelan L, Worth S, Groot S, Gates R (2023 Sept) Type II Congenital Pyloric Atresia with Desquamative Enteropathy Diagnosed Postoperatively: A Case Report. Am Surg 89(9):3838–3840 Kansra M, Raman VS, Kishore K, Khanna S, Puri B, Sharma A (2018) Congenital pyloric atresia - nine new cases: Single-center experience of the long-term follow-up and the lessons learnt over a decade. J Pediatr Surg 53(11):2112–2116 Rizzo G, Capponi A, Arduini D, Romanini C (1995) Prenatal diagnosis of gastroesophageal reflux by color and pulsed Doppler ultrasonography in a case of congenital pyloric atresia. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol 6(4):290–292 Juang D, Snyder CL (2012 June) Neonatal bowel obstruction. Surg Clin North Am 92(3):685–711 ix–x Khan YA, Zamir N (2012) Missed Congenital Pyloric Atresia with Gastric Perforation in a Neonate. J Neonatal Surg 1(2):32 Gerrie SK, Navarro OM (2023) Imaging Features of Neonatal Bowel Obstruction. Radiogr Rev Publ Radiol Soc N Am Inc 43(8):e230035 Kozlov Y, Poloyan S, Kapuller V (2021) Laparoscopic Treatment of Type I of Pyloric Atresia: Case Report. J Laparoendosc Adv Surg Tech A 31(12):1507–1510 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8823129","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":587770067,"identity":"61187736-28c6-408a-8399-09e714c5f7ae","order_by":0,"name":"Enrico 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Italy.","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Marone","suffix":""},{"id":587770069,"identity":"821678da-b30a-408a-9308-98dfd771b068","order_by":2,"name":"Domenico Noviello","email":"","orcid":"","institution":"Radiology Department, Santobono-Pausilipon Children Hospital, 80129 Naples, Italy.","correspondingAuthor":false,"prefix":"","firstName":"Domenico","middleName":"","lastName":"Noviello","suffix":""},{"id":587770302,"identity":"0183a400-90d4-44a3-a24b-6ff85b88297c","order_by":3,"name":"Dolores Ferrara","email":"","orcid":"","institution":"Radiology Department, Santobono-Pausilipon Children Hospital, 80129 Naples, Italy","correspondingAuthor":false,"prefix":"","firstName":"Dolores","middleName":"","lastName":"Ferrara","suffix":""},{"id":587770303,"identity":"2a604ae7-d93b-4333-bd48-3c39636eadd4","order_by":4,"name":"Angelina Vaccaro","email":"","orcid":"","institution":"Pediatric Unit, San Luca Hospital, Via Guglielmo Lippi Francesconi 1, 55100 Lucca, Italy","correspondingAuthor":false,"prefix":"","firstName":"Angelina","middleName":"","lastName":"Vaccaro","suffix":""},{"id":587770304,"identity":"e1a3934f-81e0-4513-b84f-4055db3dfece","order_by":5,"name":"Francesco Esposito","email":"","orcid":"","institution":"Emergency Radiology Department, Santobono-Pausilipon Children Hospital, 80129 Naples, Italy","correspondingAuthor":false,"prefix":"","firstName":"Francesco","middleName":"","lastName":"Esposito","suffix":""}],"badges":[],"createdAt":"2026-02-08 16:52:58","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8823129/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8823129/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102440414,"identity":"1043d4ec-0e30-4a65-90b9-89f2ba12cbb7","added_by":"auto","created_at":"2026-02-11 16:48:35","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":707446,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eAbove\u003c/u\u003e: Abdominal ultrasound image demonstrates a dysmorphic pyloric canal terminating in a blind end (arrow→).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eBelow\u003c/u\u003e: Lateral projection X-ray shows absent passage of contrast medium from the pylorus to the duodenum, confirming pyloric obstruction.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8823129/v1/f44f4dc3d1aa85f9cbd87f79.jpeg"},{"id":104397234,"identity":"b47121f5-cc86-4e11-91dd-b556d87eeee6","added_by":"auto","created_at":"2026-03-11 11:45:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":955233,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8823129/v1/0ceae158-281b-44b9-8912-23850115dfd6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eNon bilious Vomiting and Progressive Feeding Intolerance in a Term Neonate: not the usual suspect\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"QUESTION","content":"\u003cp\u003eA 24-hour-old male newborn with a history of polyhydramnios since the second trimester was delivered at term (41\u0026thinsp;+\u0026thinsp;1 weeks) via eutocic vaginal delivery, with a birth weight of 3,000 grams. Infant regularly urinated and passed meconium within the first hours of life. However, within 24 hours he developed progressive feeding intolerance; attempts at breastfeeding resulted in repeated, non-bilious vomiting and increasing irritability. The abdomen appeared mildly distended, but there was no overt tenderness or palpable mass. Despite normal passage of meconium, the infant exhibited poor feeding and mild dehydration. A nasogastric tube was placed, yielding significant gastric aspirate (\u0026gt;\u0026thinsp;30 mL), and abdominal distension worsened. An abdominal ultrasound and intestinal transit X-ray were performed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Based on the case presentation and what you see in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, what is your diagnosis and how would you manage this patient? (Answer given below).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"ANSWER","content":"\u003cp\u003eCongenital pyloric atresia (CPA) is a rare cause of neonatal gastric outlet obstruction, typically presenting within the first days of life. It is characterized by complete or partial interruption of the pyloric canal and may occur as an isolated anomaly or in association with other congenital conditions, such as epidermolysis bullosa [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Typical clinical features include early-onset non-bilious vomiting, progressive feeding intolerance, and signs of dehydration, as observed in this case [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrenatal polyhydramnios represents an important diagnostic clue for proximal gastrointestinal obstruction. It results from impaired fetal swallowing and is commonly associated with conditions such as congenital pyloric atresia, duodenal atresia, and esophageal atresia. Prenatal ultrasound may also reveal an enlarged fetal stomach, further supporting the suspicion of gastric outlet obstruction [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiagnosis first relies on imaging, as abdominal ultrasound may reveal a markedly distended stomach with no distal air, eventually an atresic pyloric end without continuity into the duodenum, as in our case [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Abdominal X-ray typically demonstrates a \"single bubble\" sign\u0026mdash;air confined to the stomach with absence of distal gas due to its failure to pass through the pylorus, resulting in the absence of normal intestinal gas pattern [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The differential diagnosis of a single bubble includes hypertrophic pyloric stenosis and a gastric duplication cyst. However, unlike gastric or pyloric atresia hypertrophic pyloric stenosis shows some gas visible distally due to partial, not complete, obstruction. Upper gastrointestinal contrast studies with a contrast agent further confirm the diagnosis by showing failure of contrast to pass beyond the pylorus [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin differential diagnosis, hypertrophic pyloric stenosis is unlikely in the immediate neonatal period, as it typically presents after the second to third week of life. Duodenal atresia is usually associated with a \u0026ldquo;double-bubble\u0026rdquo; sign on abdominal radiography and often presents with earlier and more severe abdominal distension. Malrotation with volvulus may present with vomiting and abdominal distension; however, it more commonly causes bilious emesis and is often associated with acute clinical deterioration [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInitial management consists of prompt gastric decompression with a nasogastric tube, correction of fluid and electrolyte imbalances, and stabilization of the neonate prior to surgery. Definitive treatment of congenital pyloric atresia is surgical, with procedure depending on the anatomical subtype. Minimally invasive laparoscopic approaches have been successfully reported and may offer advantages in select cases. In our patient, a laparoscopic surgical approach was successfully performed, with an uneventful postoperative course and good feeding tolerance at follow-up [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eI confirm that the legal guardian consented to participate and publish the clinical case.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report describes the clinical course of a single patient using de-identified data and images. Ethics approval is not required for single anonymized case reports according to our institutional policies: \u003cu\u003eThe Central Emilia Wide Area Ethical Committee of the Emilia-Romagna Region\u003c/u\u003e (CE-AVEC), located at the IRCCS Azienda Ospedaliero - Universitaria di Bologna, Policlinico di S. Orsola, established by regional resolutions n. 923 of 05/06/2023 and n.1028 of 19/06/2023.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSakamoto N, Masumoto K, Aoyama T, Shirane K, Homma Y (2024) Pyloric Atresia in a Neonate With Epidermolysis Bullosa: A Case Report. Clin Case Rep 12(12):e9685\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan P (2021) Congenital Pyloric Atresia and Epidermolysis Bullosa: Report of a Rare Association. J Indian Assoc Pediatr Surg 26(4):256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuerta CT, Sundin A, Gilna GP, Saberi RA, Ramsey WA, O\u0026rsquo;Neil CF et al (2021) Laparoscopic-assisted Open Pyloroduodenostomy Repair of Pyloric Atresia in an Infant: A Rare Congenital Anomaly. Surg Laparosc Endosc Percutan Tech. 9(1):150\u0026ndash;152\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorton Z, Stickler E, Thelan L, Worth S, Groot S, Gates R (2023 Sept) Type II Congenital Pyloric Atresia with Desquamative Enteropathy Diagnosed Postoperatively: A Case Report. Am Surg 89(9):3838\u0026ndash;3840\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKansra M, Raman VS, Kishore K, Khanna S, Puri B, Sharma A (2018) Congenital pyloric atresia - nine new cases: Single-center experience of the long-term follow-up and the lessons learnt over a decade. J Pediatr Surg 53(11):2112\u0026ndash;2116\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRizzo G, Capponi A, Arduini D, Romanini C (1995) Prenatal diagnosis of gastroesophageal reflux by color and pulsed Doppler ultrasonography in a case of congenital pyloric atresia. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol 6(4):290\u0026ndash;292\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuang D, Snyder CL (2012 June) Neonatal bowel obstruction. Surg Clin North Am 92(3):685\u0026ndash;711 ix\u0026ndash;x\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan YA, Zamir N (2012) Missed Congenital Pyloric Atresia with Gastric Perforation in a Neonate. J Neonatal Surg 1(2):32\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerrie SK, Navarro OM (2023) Imaging Features of Neonatal Bowel Obstruction. Radiogr Rev Publ Radiol Soc N Am Inc 43(8):e230035\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKozlov Y, Poloyan S, Kapuller V (2021) Laparoscopic Treatment of Type I of Pyloric Atresia: Case Report. J Laparoendosc Adv Surg Tech A 31(12):1507\u0026ndash;1510\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Santobono Children's Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8823129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8823129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA term male newborn with a prenatal history of polyhydramnios developed progressive feeding intolerance and repeated non-bilious vomiting within the first 24 hours of life, despite normal passage of meconium. Physical examination revealed mild abdominal distension without tenderness. Significant gastric aspirate was obtained via nasogastric tube. Imaging demonstrated findings consistent with gastric outlet obstruction. The diagnosis of \u003cstrong\u003econgenital pyloric atresia\u003c/strong\u003e, a rare cause of neonatal non-bilious vomiting, was established. Prompt surgical intervention following stabilization is required to prevent complications and ensure favorable outcomes.\u003c/p\u003e","manuscriptTitle":"Non bilious Vomiting and Progressive Feeding Intolerance in a Term Neonate: not the usual suspect","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 16:48:31","doi":"10.21203/rs.3.rs-8823129/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab4b98e7-5470-4151-8514-d9f677664574","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T16:48:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 16:48:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8823129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8823129","identity":"rs-8823129","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}