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Newborn infants with bilious vomiting: a national audit of neonatal transport services
Shalini Ojha1,2, Laura Sand3, Nandiran Ratnavel4
1Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK.
Insights
Bilious vomiting in infants requires investigation for surgical issues. While 22% of referred infants had surgical diagnoses, not all cases necessitate
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Audit
Background:
- The precautionary principle for investigating infant bilious vomiting leads to increased referrals to tertiary centers.
- Current referral practices may over-classify non-urgent cases as 'time-critical'.
- Understanding the frequency of surgical diagnoses is crucial for resource allocation and data management.
Purpose of the Study:
- To quantify referrals of infants with bilious vomiting to transport teams and surgical centers in the UK.
- To determine the actual frequency of surgical diagnoses in these infants.
- To inform the classification of these referrals within national 'time-critical' datasets.
Main Methods:
- A prospective, multicentre UK-wide audit was conducted from August to October 2015.
- Included were term infants (≤7 days) referred for transfer due to bilious vomiting.
- Data collected included transport details and 7-day post-transfer outcomes.
Main Results:
- 165 cases were analyzed across 16 contributing teams.
- Surgical diagnoses were identified in 22% of cases; 7% had conditions where delayed treatment risked bowel loss.
- While most surgical issues were clinically or radiographically predictable, two cases with normal X-rays required surgery.
Conclusions:
- Infants with bilious vomiting warrant investigation for potential surgical pathologies.
- The study does not support the automatic designation of all such referrals as 'time-critical'.
- Clinical collaboration and case-by-case assessment are recommended for transfer decisions.
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 and determine the frequency of surgical diagnoses with the purpose to inform the consequent inclusion of these referrals in the national 'time-critical' data set.
Methods:
A prospective, multicentre UK-wide audit was conducted between 1 August, 2015 and 31 October, 2015. Term infants aged ≤7 days referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at 7 days after transfer were collected by the local teams and transferred 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 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.
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