Newborn infants with bilious vomiting: a national audit of neonatal transport services

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, determine the frequency of surgical diagnoses, with the purpos...

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Main Authors: Ojha, Shalini, Sand, Laura, Ratnavel, Nanadiran, Kempley, Stephan, Sinha, Ajay, Mohinuddin, Syed, Budge, Helen, Leslie, Andrew
Format: Article
Published: BMJ 2017
Subjects:
Online Access:https://eprints.nottingham.ac.uk/50860/
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author Ojha, Shalini
Sand, Laura
Ratnavel, Nanadiran
Kempley, Stephan
Sinha, Ajay
Mohinuddin, Syed
Budge, Helen
Leslie, Andrew
author_facet Ojha, Shalini
Sand, Laura
Ratnavel, Nanadiran
Kempley, Stephan
Sinha, Ajay
Mohinuddin, Syed
Budge, Helen
Leslie, Andrew
author_sort Ojha, Shalini
building Nottingham Research Data Repository
collection Online Access
description 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, determine the frequency of surgical diagnoses, with the purpose to inform the consequent inclusion of these referals in the national 'time critical' dataset. Method: A prospective, multi-centre UK-wide audit was conducted (01 August 2015 to 31 October 2015). Term infants, ≤ 7 days of age, referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at seven days after transfer were collected by the local teams and tranferred 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 of this study 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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spelling nottingham-508602020-05-04T18:45:04Z https://eprints.nottingham.ac.uk/50860/ Newborn infants with bilious vomiting: a national audit of neonatal transport services Ojha, Shalini Sand, Laura Ratnavel, Nanadiran Kempley, Stephan Sinha, Ajay Mohinuddin, Syed Budge, Helen Leslie, Andrew 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, determine the frequency of surgical diagnoses, with the purpose to inform the consequent inclusion of these referals in the national 'time critical' dataset. Method: A prospective, multi-centre UK-wide audit was conducted (01 August 2015 to 31 October 2015). Term infants, ≤ 7 days of age, referred for transfer due to bilious vomiting were included. Data at the time of transport and outcomes at seven days after transfer were collected by the local teams and tranferred 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 of this study 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. BMJ 2017-05-08 Article PeerReviewed Ojha, Shalini, Sand, Laura, Ratnavel, Nanadiran, Kempley, Stephan, Sinha, Ajay, Mohinuddin, Syed, Budge, Helen and Leslie, Andrew (2017) Newborn infants with bilious vomiting: a national audit of neonatal transport services. Archives of Disease in Childhood, 102 (6). F515-518. ISSN 1468-2044 Neonatology Paediatric Surgery Transport Health Service Research Bilious Vomiting http://fn.bmj.com/content/102/6/F515.long doi:10.1136/archdischild-2016-312208 doi:10.1136/archdischild-2016-312208
spellingShingle Neonatology
Paediatric Surgery
Transport
Health Service Research
Bilious Vomiting
Ojha, Shalini
Sand, Laura
Ratnavel, Nanadiran
Kempley, Stephan
Sinha, Ajay
Mohinuddin, Syed
Budge, Helen
Leslie, Andrew
Newborn infants with bilious vomiting: a national audit of neonatal transport services
title Newborn infants with bilious vomiting: a national audit of neonatal transport services
title_full Newborn infants with bilious vomiting: a national audit of neonatal transport services
title_fullStr Newborn infants with bilious vomiting: a national audit of neonatal transport services
title_full_unstemmed Newborn infants with bilious vomiting: a national audit of neonatal transport services
title_short Newborn infants with bilious vomiting: a national audit of neonatal transport services
title_sort newborn infants with bilious vomiting: a national audit of neonatal transport services
topic Neonatology
Paediatric Surgery
Transport
Health Service Research
Bilious Vomiting
url https://eprints.nottingham.ac.uk/50860/
https://eprints.nottingham.ac.uk/50860/
https://eprints.nottingham.ac.uk/50860/