title: Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort.
abstract: Bilious vomiting in a neonate may be a sign of intestinal obstruction often resulting in transfer requests to surgical centres. The aim of this study was to assess the use of clinical findings at referral in predicting outcomes and to determine how often such patients have a time-critical surgical condition (eg, volvulus, where a delay in treatment is likely to compromise gut viability).
  
  
  METHODS
  4-year data and outcomes of all term newborns aged ≤7 days with bilious vomiting transferred by a regional transfer service were analysed. Specificity, sensitivity, likelihood ratios, correlations, prior and posterior probability of clinical findings in predicting newborns with surgical diagnosis were calculated.
  
  
  RESULTS
  Of 163 neonates with bilious vomiting, 75 (46%) had a surgical diagnosis and 23 (14.1%) had a time-critical surgical condition. The diagnosis of a surgical condition in neonates with bilious vomiting was significantly associated with abdominal distension (χ(2)=5.17, p=0.023), abdominal tenderness (χ(2)=5.90, p=0.015) and abnormal abdominal X-ray findings (χ(2)=5.68, p=0.017) but not with palpation findings of a soft as compared with a tense abdomen (χ(2)=3.21, p=0.073). Abnormal abdominal X-ray, abdominal distension and tenderness had 97%, 74% and 62% sensitivity, respectively, with regard to association with an underlying surgical diagnosis. Normal abdominal X-ray reduced the posterior probability of surgical diagnosis from 50% to 16%. Overall, clinical findings at referral did not differentiate between infants with or without surgical or time-critical condition.
  
  
  CONCLUSIONS
  We recommend that term neonates with bilious vomiting referred for transfer are prioritised as time critical.
authors.affiliation: Neonatal Transfer Service, Barts Health NHS Trust, London, UK.
authors.forename: Syed
authors.initials: S
authors.lastname: Mohinuddin
authors.affiliation: Neonatal Transfer Service, Barts Health NHS Trust, London, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Sakhuja
authors.affiliation: Neonatal Transfer Service, Barts Health NHS Trust, London, UK.
authors.forename: Benjie
authors.initials: B
authors.lastname: Bermundo
authors.affiliation: Neonatal Transfer Service, Barts Health NHS Trust, London, UK.
authors.forename: Nandiran
authors.initials: N
authors.lastname: Ratnavel
authors.affiliation: Department of Neonatal Medicine, Barts Health NHS Trust, London, UK Blizard Institute, Queen Mary School of Medicine and Dentistry, University of London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kempley
authors.affiliation: Department of Paediatric Surgery, Barts Health NHS Trust, London, UK.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Ward
authors.affiliation: Department of Neonatal Medicine, Barts Health NHS Trust, London, UK Blizard Institute, Queen Mary School of Medicine and Dentistry, University of London, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Sinha
mesh_terms: D001646:Bile; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D014839:Vomiting / Q000175:diagnosis*
keywords: Neonatology; Paediatric Practice; Paediatric Surgery