Infant Journal
for neonatal and paediatric healthcare professionals

Neonatal bilious vomiting: risk factors for surgical pathology

Bilious vomiting (BV) in newborn infants is an important presenting sign of intestinal obstruction. To determine the incidence and associated risk factors for surgical pathology in this population, we conducted a review of the presentation and management of term neonates with BV admitted to a neonatal intensive care unit. More than 50% of babies with BV presented within the first 24 hours but surgical pathology was more likely in infants who presented after 24 hours. Abdominal distension was a major risk factor for surgical pathology in infants with BV. Abdominal plain radiographs demonstrated a high sensitivity and specificity for predicting surgical pathology.

David A Cummins
Neonatal Consultant, Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
ORCID: 0000-0002-8116-7675
Twitter: @dcumminsno9

Carl A Kuschel
Neonatal Consultant, Royal Women’s Hospital Melbourne, Australia

Cummins D.A., Kuschel C.A. Neonatal bilious vomiting: risk factors for surgical pathology. Infant 2023; 19(3): 100-04.

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bilious vomiting; abdominal plain radiographs; upper gastrointestinal contrast studies; Hirschsprung’s disease; malrotation
Key points
  1. Larger multicentre cohort studies may improve our understanding of the timing of BV and its link to surgical pathology.
  2. Improving access to upper gastrointestinal contrast studies may reduce the need for unnecessary transfers to surgical centres.
  3. Understanding risk factors may help in parental discussions while awaiting investigations.

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