preterm baby his BW is 1000g, enter nicu for gaining wt firstly brown aspirate with trophic feeding then start greenish aspirate and dealed as NEC , so NPO for 1 w without stopping of greenish aspirate reach till 15 ml/day, so gastrograffin study was done and revealed free study and baby pass motion in spite green aspirate so i start with him erythromycin as pro-kinetic drug for 1 w and stop and start feeding again very slowly and now he tolerate 3cc/kg every 3h with no residual now what is your opinion in this case , what is possible diagnosis????

Can u tell more about x ray findings, based on what findings NEC was diagnosed. Free study of gastrografin means what?

Continous feeds may help. Donot check aspirates untill baby is nauseating.

gastrograffin followthrough was free , dye passed to colon

x ray abd show dilated distended loops of intestine and thick wall 

First of all there is no need to keep on looking residuals when you start feeding the preterms unless there are other signs like abdominal distension which is more definitive indication of possible NEC. Tube in duodenum or in lower area can result in greenish aspirates. Feeding itself has certain pro kinetic effects.

Sent from my iPad using Tapatalk

It is not uncommon for preterm baby to get greenish aspirate , be sure that OGT not very low position , consider sepsis all the time as one of UR DD , try to start feeding with mother milk. Try metclorpromide it may help.

Did you measure the gastric pH? One of the multiples sign of estress is the feeding intolerance, and the low gastirc pH. Pain or overstimulation could be the cause. In this case the resolution of the case is easy... don´t disturb!! :-D
Last week I found a gastric aspirate green coloured (brilliant green) the pH was 1-2!! The doctor prescribed ranitidine for gastric protection.

This baby I talked about him was persist green aspirate for 2 w and large amount about 10_20 cc\day and without any and distension and was pass stool scanty amount and not show any improvement except after given erythromycinfor 1 w

Strange! Is the baby still not given enteral feeds?

Are regular blood tests normal (blood counts incl trombocytes, CRP, acidbase, electorlytes)?

Baby proceed in feeding till 10ml/2h then acquired sepsis