During the first 24 hours of life, which of these signs may be the FIRST indication that a newborn may have Hirschsprung's disease?
a. has projectile vomiting and visible peristaltic waves
b. fails to pass a stool
c. has numerous black, tarry, mucous stools
d. turns dusky and chokes during any attempt at oral feedings
B
Hirschsprung's disease/megacolon is a partial or complete mechanical obstruction resulting from inadequate motility of part of the colon. There is an absence of parasympathetic ganglion cells, which causes an absence of peristalsis. The affected portion of the bowel narrows, becomes dilated, and fills with feces and gas. An infant usually does not have a bowel movement within the first 24 hours. The nurse should assess for passage of stool in the first 24 hours, observe for constipation and malformed stools, and assess weight gain and nutritional status.
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