Bilious vomiting in the newborn: How often is it pathologic?☆
Section snippets
Materials and methods
All neonates with a history of bilious vomiting referred to a regional pediatric surgical unit during a 2-year period (September 1998 to September 2000) were prospectively audited. Only infants with “green” vomiting witnessed by an experienced nurse, midwife, or doctor were included. Neonates with bilious nasogastric aspirates but no vomiting were not included. Demographic details, symptomatology, investigations, and final diagnosis were recorded. Routine clinical care remained unchanged during
Results
Sixty-three consecutive neonates (35 boys, 28 girls), in whom the dominant presenting feature was bilious vomiting, were identified. Their median gestational age was 40 weeks (range, 31 to 42) and birth weight was 3.5 kg (range, 1.67 to 4.64). Median age at presentation was 26 hours (range, 9 hrs to 28 days). Fifty were delivered vaginally (2 by forceps and 1 by ventouse extraction) and 13 by cesarian section. Forty-nine (78%) passed meconium within 24 hours of birth, and 11 of these had
Discussion
This prospective study shows that bilious vomiting in the neonatal period is not invariably associated with intestinal obstruction. This was the underlying cause in 38% of our cases. In the only previously published study of bilious vomiting in the newborn, a similar proportion of neonates (31 of 45 [69%]) were found to have no obvious surgical cause and were categorized as having idiopathic bilious vomiting.3 This same study found no correlation between delayed passage of meconium (>24 hr) and
Acknowledgements
The authors thank their pediatric surgical colleagues whose patients were included in this audit.
References (9)
Imaging of neonatal gastrointestinal obstruction
Radiol Clin North Am
(1999)- et al.
A longitudinal study of electrogastrography in normal neonates
J Pediatr Surg
(2000) Intestinal obstruction: General considerations, in Neonatal Surgery
Pediatric Surgery
(1958)
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2019, Shackelford's Surgery of the Alimentary Tract: 2 Volume SetAn audit of bilious vomiting in term neonates referred for pediatric surgical assessment: can we reduce unnecessary transfers?
2018, Journal of Pediatric SurgeryCitation Excerpt :This discovery lead to regional educational interventions to encourage early referral to facilitate prompt surgical management, particularly in time critical diagnoses, in the hope of improving outcomes. In our series, 76% of neonates had no explanation for bilious emesis before discharge, higher than in previous reports (48%–65%) [2,7,10]. This may be explained by the lower threshold in referral that the surgical service has driven.
Bilious vomiting in two neonates due to an urinoma secondary to posterior urethral valves
2015, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Bilious vomiting in infancy should always be thought of as abnormal [18] and the diagnosis of malrotation should be considered. Other common surgical causes of bilious vomiting include Hirschsprung's, intestinal atresia, intestinal malrotation, meconium ileus, meconium plug & milk inspissation [1], ano-rectal malformation [19] & intestinal duplication cysts [20]. Though two studies have reported that surgical causes of bilious vomiting in neonates were identified in only 38% of all patients, these diagnoses must be made promptly as prolonged bowel ischemia can lead to devastating consequences including extensive bowel loss or even death [1,19].
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Address reprint requests to M.D. Stringer, Department of Paediatric Surgery, Ward 11, Gledhow Wing, St James University Hospital, Beckett St, Leeds LS9 7TF, England.