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The burden of excluding malrotation in term neonates with bile stained vomiting

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Abstract

Purpose

To determine the number of term infants with bilious vomiting (BV) referred to a neonatal surgical centre for exclusion of malrotation by upper gastrointestinal contrast (UGI) examination.

Methods

Retrospective review of term (>37/40) neonates <28 days of age undergoing UGI for exclusion of malrotation between Jan 2010 and Dec 2014 in a neonatal network with 30,000 term deliveries annually. Only infants with BV in the absence of alternative clinical/radiological diagnosis were included.

Results

One hundred and sixty-six infants met the inclusion criteria. Fourteen (9 %) infants had malrotation diagnosed by UGI and confirmed at laparotomy. Only 1 of 110 infants referred at 0–2 days of age had positive UGI compared to 13 of 56 infants referred after this age (p < 0.01). An increase in referrals followed the death of an infant from midgut volvulus and as a result one in 500 term infants are currently being referred.

Conclusion

Increasing awareness of the potential consequences of bilious vomiting appears to have resulted in increased referrals with no increase in detection of malrotation. Prospective studies are required to determine whether investigation of all infants with unexplained bilious vomiting is required and if it is possible to select cases for surgical referral.

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Acknowledgements

NJH is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre.

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Authors and Affiliations

  1. Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK

    Melanie Drewett, Nav Johal, Charles Keys, Nigel J Hall & David Burge

  2. Faculty of Medicine, University of Southampton, Southampton, UK

    Nigel J Hall

Authors
  1. Melanie Drewett
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  2. Nav Johal
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  3. Charles Keys
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  4. Nigel J Hall
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  5. David Burge
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Corresponding author

Correspondence to David Burge.

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Ethical statement

This study received institutional approval as a service evaluation. No specific patient information is included.

Conflict of interest

The authors declare that they have no conflict of interest.

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Drewett, M., Johal, N., Keys, C. et al. The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatr Surg Int 32, 483–486 (2016). https://doi.org/10.1007/s00383-016-3877-2

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  • DOI: https://doi.org/10.1007/s00383-016-3877-2

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