RT Journal Article SR Electronic T1 Newborn infants with bilious vomiting: a national audit of neonatal transport services JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP F515 OP F518 DO 10.1136/archdischild-2016-312208 VO 102 IS 6 A1 Shalini Ojha A1 Laura Sand A1 Nandiran Ratnavel A1 Stephen Terence Kempley A1 Ajay Kumar Sinha A1 Syed Mohinuddin A1 Helen Budge A1 Andrew Leslie YR 2017 UL http://fn.bmj.com/content/102/6/F515.abstract AB 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.