An audit of bilious vomiting in term neonates referred for pediatric surgical assessment: can we reduce unnecessary transfers?
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In brief
In brief
Audit of 111 term neonates with bilious vomiting found only 11.7% had surgical pathology requiring intervention. Age >72 hours and abdominal distension predicted surgical pathology, but only contrast fluoroscopy reliably excluded it, limiting ability to reduce unnecessary neonatal transfers.
Written by the GCMD Library team from the article.
Background
Between 20% and 50% neonates with bilious vomiting are diagnosed with surgical pathology. Distinguishing neonates requiring surgery remains challenging. Our aim was to conduct an audit of term neonates with bilious vomiting referred for assessment to identify characteristics of this cohort and management. Secondary aims were to identify factors predictive of surgical pathology.
Methods
Infants 72 h, presence of abdominal distension, raised CRP and abnormal X-ray were statistically significant predictors of surgical pathology, while only the former two were predictive of time-critical surgical pathology.
Conclusion
11.7% neonates had surgical pathology, fewer than in previous studies. Only contrast fluoroscopy could exclude surgical pathology and therefore prevent transfer. A more sensitive, widely available test would be required to reduce unnecessary neonatal transfers.
Type of study
Prognosis study.
Level of evidence
Level III.