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Predicting Time-Critical Pathology and Cardiorespiratory Deterioration in Infants Retrieved for Bilious Vomiting: An
1South Australia Ambulance Service MedSTAR Kids, Adelaide Airport, South Australia, Australia.
Insights
Infants with bilious vomiting requiring cardiorespiratory support are at higher risk for critical pathology and deterioration during retrieval. This highlights the need for timely, well-equipped retrieval responses for these vulnerable infants.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Emergency Medicine
Background:
- Bilious vomiting in infants often signals surgical issues, necessitating inter-hospital retrieval for specialized care.
- Timely assessment and management are crucial for infants with bilious vomiting due to potential surgical pathology.
Purpose of the Study:
- To determine the incidence of surgical pathology, time-critical conditions, and cardiorespiratory deterioration in infants with bilious vomiting during retrieval.
- To investigate the association between the need for cardiorespiratory support upon referral and the likelihood of time-critical pathology or deterioration during retrieval.
Main Methods:
- A retrospective observational study was conducted on 104 infants under 44 weeks corrected gestational age.
- Data were collected over 103 months from an Australian retrieval service's electronic records for infants presenting with bilious vomiting or aspirates.
Main Results:
- Surgical pathology was identified in 20.19% of infants, time-critical pathology in 5.77%, and cardiorespiratory deterioration occurred in 9.62% during retrieval.
- Infants needing cardiorespiratory support at referral had a significantly higher likelihood of time-critical pathology (RR 6.93) and cardiorespiratory deterioration (RR 9.24) during retrieval.
Conclusions:
- Findings aid retrieval services in optimizing response planning for infants with bilious vomiting.
- Increased awareness of critical pathology risks and deterioration in supported infants can inform response timing and team composition for improved patient outcomes.
Objective:
Bilious vomiting in infants is recognized as a sign of potential surgical pathology, and these infants often require retrieval from the peripheral hospital to a surgical center for specialist investigation. We set out to show the frequency of surgical pathology, time-critical pathology, and cardiorespiratory deterioration during retrieval among infants with bilious vomiting. In addition, we aimed to show whether there is an association between the need for cardiorespiratory support at the time of referral and time-critical pathology or cardiorespiratory deterioration during the retrieval.
Methods:
We completed a retrospective observational study of 104 infants younger than 44 weeks' corrected gestational age retrieved for bilious vomiting or aspirates over a 103-month period identified from the electronic retrieval record database of an Australian retrieval service.
Results:
Of the infants included in the study, 21 (20.19%) had a surgical pathology, 6 (5.77%) had a time-critical pathology, and 10 (9.62%) experienced a cardiorespiratory deterioration during the retrieval. Infants receiving cardiorespiratory support at the time of referral were more likely to have a time-critical pathology (risk difference [RD], 24.45%; 95% confidence interval [CI], 3.23-60.07; risk ratio [RR], 6.93; 95% CI, 1.52-31.5) and more likely to experience a cardiorespiratory deterioration (RD, 50.95%; 95% CI, 18.17-78.19; RR, 9.24; 95% CI, 3.38-25.27).
Conclusion:
Our findings can help the retrieval service plan their response to referrals for infants with bilious vomiting. Awareness of the frequency of time-critical pathology and of deterioration during retrieval and the increased risk of both among those requiring cardiorespiratory support at the time of referral could inform the timing of response and team composition.
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