Vomiting:It is a reflex action of the stomach contents and part of the small intestine contents retrograde in the digestive tract and expelled from the mouth, which is a manifestation of the dysfunction of the digestive tract. Neonatal: ①Anatomical and physiological reasons for neonatal. ② Abnormalities in the differentiation and development of each organ during the embryonic period. ③ Stimulation at birth of the fetus. ④The neonatal vomiting center is not well developed. The vomiting center is located at the base of the fourth ventricle of the medulla oblongata. The afferent nerves are mainly the vagus, visceral, vestibular, glossopharyngeal, optic and olfactory nerves. The efferent nerves are the vagus, visceral, phrenic, ventral spinal, and linguopharyngeal nerves. The vomiting center is adjacent to the respiratory center, autonomic center, salivary nucleus and vestibular nucleus, so it is often accompanied by pallor, sweating, excessive salivation, change in pulse and respiratory rate before and during vomiting. Analysis of several symptoms 1. Vomiting Pay attention to its occurrence, manifestation and changes Time and number The time when vomiting starts to appear and the number of vomiting per day can vary significantly depending on the disease. Newborns begin to vomit coffee-colored mucus within a few hours after birth and 3-year-olds repeatedly vomit coffee-colored material for more than 2 years apparently from different causes. The former may be due to accidental swallowing of maternal blood, while the latter has a higher chance of esophageal hiatal hernia. Vomiting characteristics: vomiting is obvious when lying down and may be jet vomiting, vomit is milk and may contain brown or coffee-colored blood. Gastric ulceration can occur in paraesophageal hernia, and occasionally gastric necrosis can occur, requiring emergency surgical management. The manner of vomiting may be spill-like, such as milk coming out of the corners of the newborn’s mouth in small amounts; or gushing back from the mouth; or spitting up in large amounts from the mouth; or spurting from both the mouth and nostrils. The former may be physiological in the neonatal period, while the latter is most often seen in congenital hypertrophic pyloric stenosis. Congenital hypertrophic pyloric stenosis Vomiting characteristics: timing: usually begins around the second week after birth. Nature: persistent, progressive, gradually developing into ejectile vomiting. Nature of vomit: lactic-like substance, large amount, sour odor, no bile. Hunger feeling after vomiting. 3.Content and nature Content and nature have important reference value for the diagnosis of GI obstruction. Clear or foamy mucus, undigested milk or food Indicates obstruction of saliva downstream and obstruction above the cardia. It is seen in neonates with congenital esophageal atresia, esophageal stricture due to food inflammation in all age groups and cardia incontinentia Esophageal atresia and esophagotracheal fistula Incidence: 1/3000-1/4500, about 1/3 in premature infants. Typology: The disease is divided into 5 types, type I and type II gastrointestinal tract is not inflated, type III, IV and V gastrointestinal tract are inflated. Clinically, type III is the most common, accounting for about 85% to 90% of all children. The manifestations are choking, cyanosis and aspiration pneumonia, and even asphyxia. The lower nasogastric tube is obstructed or folded back in the oral cavity. Cardia achalasia occurs mostly in adolescents and adults, but only less than 5% of children before the age of 4 years. It is characterized by intermittent swallowing difficulties, milk spillage after breastfeeding, and slow weight gain. On barium fluoroscopy, the esophagus is seen to be dilated, the cardia is narrow, there are no or few peristaltic waves in the esophagus, the liquid level is sometimes seen in the esophagus, and there is little or no gas in the stomach. Gastroesophageal reflux Clinical manifestations: vomiting, esophagitis, aspiration syndrome. Indications for surgery: (1) No improvement after 6 weeks of continuous medical treatment. (2) Recurrent aspiration pneumonia or with asphyxia. (3) Anemia due to esophageal bleeding. (4) Esophageal stricture. Intestinal atresia There can be high intestinal atresia and low, poor intestinal rotation At about 10 weeks of embryonic age, there is a left-to-right counterclockwise rotation of the midgut during its retraction into the abdominal cavity, and aborted rotation of the midgut at any time can cause poor intestinal rotation. Vomiting characteristics: Vomiting usually starts 3-5 days after birth, vomiting can be intermittent, sometimes light and sometimes heavy, vomit is milk, containing bile. Congenital megacolon The first symptoms are delayed expulsion of feces, constipation, and abdominal distension. Most of the symptoms of low intestinal obstruction appear 2 to 6 days after birth. These symptoms can be repeated.