Which of the following is most suggestive of neonatal small bowel obstruction -

Generalized abdominal distention is more indicative of large bowel obstruction. In small bowel obstruction the distention is mild to massive depending on the site of obstruction (minimal or absent in proximal & mild to massive in distal) and is usually central and not generalized. Failure to pass meconium in the first 24 hrs is a feature of obstruction as in Hirschprung's disease. Refusal to feed is a common but nonspecific symptom. The most common symptom suggestive of small bowel obstruction is bilious vomiting.