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Newborn infants with bilious vomiting: a national audit of neonatal transport services

Ojha, Shalini; Sand, Laura; Ratnavel, Nanadiran; Kempley, Stephan; Sinha, Ajay; Mohinuddin, Syed; Budge, Helen; Leslie, Andrew

Authors

SHALINI OJHA Shalini.Ojha@nottingham.ac.uk
Professor of Neonatal Medicine

Laura Sand

Nanadiran Ratnavel

Stephan Kempley

Ajay Sinha

Syed Mohinuddin

HELEN BUDGE HELEN.BUDGE@NOTTINGHAM.AC.UK
Professor of Neonatal Medicine

Andrew Leslie



Abstract

Objective: The precautionary approach to urgently investigate infants with bilious vomiting has increased the numbers referred to transport teams and tertiary surgical centres. The aim of this national UK audit was to quantify referrals, determine the frequency of surgical diagnoses, with the purpose to inform the consequent inclusion of these referals in the national 'time critical' dataset.
Method: A prospective, multi-centre UK-wide audit was conducted (01 August 2015 to 31 October 2015). Term infants, ≤ 7 days of age, referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at seven days after transfer were collected by the local teams and tranferred anonymously for analysis.
Results: Sixteen teams contributed data on 165 cases. Teams that consider such transfers as “time-critical” responded significantly faster than those that do not classify bilious vomiting as time-critical. There was a surgical diagnosis in 22% cases and 7% had a condition where delayed treatment may have caused bowel loss. Most surgical problems could be predicted by clinical and/or X-ray findings but two infants with normal X-ray features were found to have a surgical problem.
Conclusion: The results of this study support the need for infants with bilious vomiting to be investigated for potential surgical pathologies, but the data do not provide evidence for the default designation of such referrals as “time critical.” Decisions should be made by clinical collaboration between the teams and, where appropriate, swift transfer provided.

Citation

Ojha, S., Sand, L., Ratnavel, N., Kempley, S., Sinha, A., Mohinuddin, S., …Leslie, A. (2017). Newborn infants with bilious vomiting: a national audit of neonatal transport services. Archives of Disease in Childhood, 102(6), Article F515-518. https://doi.org/10.1136/archdischild-2016-312208

Journal Article Type Article
Acceptance Date Mar 20, 2017
Publication Date May 8, 2017
Deposit Date Apr 5, 2018
Publicly Available Date Mar 28, 2024
Journal Archives of Disease in Childhood
Print ISSN 0003-9888
Electronic ISSN 1468-2044
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 102
Issue 6
Article Number F515-518
DOI https://doi.org/10.1136/archdischild-2016-312208
Keywords Neonatology, Paediatric Surgery, Transport, Health
Service Research, Bilious Vomiting
Public URL https://nottingham-repository.worktribe.com/output/859729
Publisher URL http://fn.bmj.com/content/102/6/F515.long

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