How should the neonatal retrieval team respond to the neonate referred with bilious vomiting?

Aim Bilious vomiting (BV) in the neonatal period may herald malrotation with life‐threatening volvulus. In New South Wales, contrast fluoroscopy is not available in non‐tertiary paediatric centres; therefore, transfer is required. An infant with BV referred to Newborn and Paediatric Emergency Transport Service is prioritised for urgent retrieval to a surgical centre for contrast fluoroscopy and paediatric surgical review. This study analysed how many neonates with BV needed retrieval to prevent bowel loss or to save one life and to identify predictors of malrotation and/or volvulus. Methods All neonatal referrals (140 (P = 0.04) and decreased for each kilogram of birthweight (odds ratio 0.475; confidence interval 0.294–0.768). Conclusions Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby.