Bilious vomiting in the newborn: how often is further investigation undertaken?

Walker, Gregor; Raine, P.A.M.

doi:10.1016/j.jpedsurg.2006.12.017

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…In addition, we have no information regarding infants who may have presented with bilious vomiting but were not referred. A survey of neonatologists revealed variations in management and demonstrated that many infants with bilious vomiting may not be referred 7. These unknown variations may have introduced a bias in the data presented.…”

Section: Discussionmentioning

confidence: 99%

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

Ojha

Sand

Ratnavel

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ojha

Sand

Ratnavel

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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“…Most neonates developing bilious vomiting are not born in neonatal surgical centres and are transferred to such facilities 2. These infants are often transferred beyond their local networks 3.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

et al. 2014

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“…Standard teaching in pediatric surgery mentions that bile vomiting in a neonate indicates intestinal obstruction until proven otherwise (1). There are studies which show that bilious vomiting in the neonatal period is not invariably associated with intestinal obstruction and the rate of intestinal obstruction may be as low as 38% (4, 5).…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of clinical signs or a plain abdominal film allowing a positive diagnosis, an upper gastrointestinal (UGI) contrast study is recommended to specifically exclude intestinal malrotation and volvulus (1, 2) which are the most emergent differential diagnoses. There are limitations for X-ray studies in neonates including radiation hazards, physical trauma such as the risk of hypothermia, difficult positioning and being time consuming (3).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound in Determining the Cause of Bilious Vomiting in Neonates

et al. 2012

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BackgroundPlain radiography and contrast radiologic studies are traditionally the main options in evaluating neonates presenting with bilious vomiting. While ultrasonography (US) is more available, its diagnostic accuracy is in question.ObjectivesThe purpose of this study is to determine the diagnostic accuracy of US in evaluating these patients with bilious vomiting.Patients and MethodsAll neonates with bilious vomiting or bilious nasogastric tube drainage presented to a children’s hospital in a 1.5-year period were included. US were performed in all patients. The results were compared with clinical and radiological data and the final diagnosis. We used chi-square and Fisher’s exact tests for analysis.ResultsThe cause of bilious vomiting for 18 of the 23 included patients was surgical. All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%]. The sensitivity and specificity of US in diagnosing intestinal atresia (n = 9) was 89% [CI 95%: (68% - 100%)] and 100%. In cases with malrotation (n = 4) and midgut volvulus (n = 2), sonographic diagnosis was in concordance with final surgical diagnosis.ConclusionThis study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

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Bilious vomiting in the newborn: how often is further investigation undertaken?

Cited by 16 publications

References 6 publications

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

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

Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

Diagnostic Accuracy of Ultrasound in Determining the Cause of Bilious Vomiting in Neonates

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