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Newborn infants with bilious vomiting: a national audit of neonatal transport services
  1. Shalini Ojha1,2,
  2. Laura Sand3,
  3. Nandiran Ratnavel4,
  4. Stephen Terence Kempley5,
  5. Ajay Kumar Sinha6,7,
  6. Syed Mohinuddin6,
  7. Helen Budge3,
  8. Andrew Leslie8
  1. 1 Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
  2. 2 Neonatal Unit, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
  3. 3 Division of Child Health, School of Medicine, University of Nottingham, Nottingham, UK
  4. 4 London Neonatal Transfer Service, The Royal London Hospital, Barts Health NHS Trust, London, UK
  5. 5 Blizard Institute, Queen Mary University of London, London, UK
  6. 6 Paediatrics, Barts Health NHS Trust, London, UK
  7. 7 Paediatrics, Barts and the London School of Medicine and Dentistry, London, UK
  8. 8 Neonatal Transport, University Hospitals of Leicester, Leicester, UK
  1. Correspondence to Dr Shalini Ojha, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham; shalini.ojha{at}nottingham.ac.uk

Abstract

Objective The precautionary approach to urgently investigate infants with bilious vomiting has increased the numbers referred to transport teams and tertiary surgical centres. The aim of this national UK audit was to quantify referrals and determine the frequency of surgical diagnoses with the purpose to inform the consequent inclusion of these referrals in the national ‘time-critical’ data set.

Methods A prospective, multicentre UK-wide audit was conducted between 1 August, 2015 and 31 October, 2015. Term infants aged ≤7 days referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at 7 days after transfer were collected by the local teams and transferred anonymously for analysis.

Results Sixteen teams contributed data on 165 cases. Teams that consider such transfers as ‘time-critical’ responded significantly faster than those that do not classify bilious vomiting as time-critical. There was a surgical diagnosis in 22% cases, and 7% had a condition where delayed treatment may have caused bowel loss. Most surgical problems could be predicted by clinical and/or X-ray findings, but two infants with normal X-ray features were found to have a surgical problem.

Conclusion The results support the need for infants with bilious vomiting to be investigated for potential surgical pathologies, but the data do not provide evidence for the default designation of such referrals as ‘time-critical.’ Decisions should be made by clinical collaboration between the teams and, where appropriate, swift transfer provided.

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Footnotes

  • Contributors SO conceptualised the study, wrote the study protocol, designed the data collection proforma, co-ordinated the project and wrote the initial manuscript. LS analysed the data and wrote the initial manuscript. NR conceptualised the study and reviewed the manuscript.

    SK conceptualised the study and reveiwed the manuscript. AS and SM conceptualised the study and reviewed the statistical analysis and the manuscript.

    HB analysed the data and contributed to the writing on the initial manuscript. AL conceptualised the study, organised the national collaboration, obtained regulatory approvals, and reviewed the manuscript. UK Neonatal Transport Group members commissioned the study, organised local regulatory approvals, data collection, and commented on the discussions and conclusion.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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