title: The burden of excluding malrotation in term neonates with bile stained vomiting.
abstract: OBJECTIVE
  To determine the number of term infants with bilious vomiting (BV) referred to a neonatal surgical centre for exclusion of malrotation by upper gastrointestinal contrast (UGI) examination.
  
  
  METHODS
  Retrospective review of term (>37/40) neonates <28 days of age undergoing UGI for exclusion of malrotation between Jan 2010 and Dec 2014 in a neonatal network with 30,000 term deliveries annually. Only infants with BV in the absence of alternative clinical/radiological diagnosis were included.
  
  
  RESULTS
  One hundred and sixty-six infants met the inclusion criteria. Fourteen (9 %) infants had malrotation diagnosed by UGI and confirmed at laparotomy. Only 1 of 110 infants referred at 0-2 days of age had positive UGI compared to 13 of 56 infants referred after this age (p < 0.01). An increase in referrals followed the death of an infant from midgut volvulus and as a result one in 500 term infants are currently being referred.
  
  
  CONCLUSIONS
  Increasing awareness of the potential consequences of bilious vomiting appears to have resulted in increased referrals with no increase in detection of malrotation. Prospective studies are required to determine whether investigation of all infants with unexplained bilious vomiting is required and if it is possible to select cases for surgical referral.
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Drewett
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Nav
authors.initials: N
authors.lastname: Johal
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Keys
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK.|Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: J Hall
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK. david.burge@uhs.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Burge
mesh_terms: D001646:Bile; D003287:Contrast Media; D004065:Digestive System Abnormalities / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology*; D045822:Intestinal Volvulus / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology*
chemical_list: D003287:Contrast Media
keywords: Intestinal obstruction; Malrotation; Neonate; Volvulus