Bilious vomiting in the newborn: 6 years data from a Level III Centre

Area of Science:

• Neonatal Surgery
• Pediatric Surgery
• Diagnostic Imaging

Background:

• Bilious vomiting in newborns is a critical condition necessitating prompt neonatal and pediatric surgical intervention.
• Standard investigations include abdominal X-ray and contrast imaging.
• This study evaluates surgical intervention rates and contrast imaging accuracy for neonatal bilious vomiting.

Purpose of the Study:

• To determine the prevalence of surgical intervention in newborns with bilious vomiting.
• To assess the reliability of contrast imaging in predicting the underlying surgical condition.

Main Methods:

• Retrospective audit of data from a level III unit (December 2001 - October 2007).
• Included newborns admitted with bilious vomiting; excluded those with bilious aspirates but no vomiting.
• Analyzed data on demographics, investigations (X-ray, contrast studies), and surgical outcomes.

Main Results:

• Sixty-one infants with bilious vomiting were analyzed; 85.2% had abnormal X-rays and 34.4% had abnormal contrast studies.
• Surgical intervention (laparotomy) was performed in 26.6% of cases, revealing conditions like malrotation with volvulus, small bowel obstruction, and Hirschsprung's disease.
• Barium contrast studies demonstrated a positive predictive value of 85.7% for accurate surgical findings.

Conclusions:

• Bilious vomiting in neonates is a surgical emergency requiring urgent investigation.
• Contrast studies remain a cornerstone in diagnosing the underlying surgical pathology.