Term neonates with bilious vomiting – should they be considered as time critical transfers to the surgical centre?

Background Bilious vomiting in a neonate can be a presenting sign of intestinal obstruction with consequences of gut compromise and long term sequelae. As it is difficult to identify the baby with an underlying surgical problem, neonates presenting with bilious vomiting are often transferred to surgical centres. The burden and outcomes of this cohort of infants on neonatal services are not described in the literature. Aims To evaluate the outcomes of infants referred with bilious vomiting to a regional neonatal transfer service. Methods A retrospective audit of transfers performed by our service during a three year period (January 2007 to January 2011). Clinical data and outcomes were collected from case records. Results During the three year period, 203 neonates with bilious vomiting were transferred. Of these, 38 records had missing outcome data and were excluded, resulting in 165 records being analysed. The median gestation was 39.5 weeks and median birth weight 3.2 Kg. A male preponderance with a ratio of 1.4 to 1 was seen. Median age at referral was 36 hours (Range 2.3-166 hours). Median response time (time interval between time of referral and transfer team arriving to the baby) was 80 minutes (IQR 55-170 minutes). Median stabilisation times were 46 minutes (IQR 40-60 minutes). Following transfer 54 (33%) infants underwent a surgical procedure. A further 17 had Hirschprungs disease which was conservatively managed, making a total of 71 (43%) of babies with a surgical condition (diagnoses shown in table 1). Abstract G200 Table 1 Diagnosis Number (Percentage) n = 165 Intestinal Atresias 21 (13) Malrotation / Volvulus / Bands 18 (11) Surgically operated Hirschprungs disease 6 (4) Necrotising Enterocolitis 3 (2) Gut Perforation (Spontaneous) 2 (1) Meconium Ileus 2 (1) Ano-rectal malformations 2 (1) TOTAL OPERATED 54 (33) Hirschprungs disease (Conservatively Managed) 17 (10) Total neonates with surgical diagnoses 71 (43) Conclusion We have demonstrated that 43% of neonates referred with bilious vomiting have a surgical condition, a quarter of whom have a diagnosis of malrotation. We recommend that transfers of such infants should be regarded as time critical and this should be taken into consideration in service and resource planning.