Aim Bilious vomiting (BV) in the neonatal period may herald malrotation with life‐threatening volvulus. In New South Wales, contrast fluoroscopy is not available in non‐tertiary paediatric centres; therefore, transfer is required. An infant with BV referred to Newborn and Paediatric Emergency Transport Service is prioritised for urgent retrieval to a surgical centre for contrast fluoroscopy and paediatric surgical review. This study analysed how many neonates with BV needed retrieval to prevent bowel loss or to save one life and to identify predictors of malrotation and/or volvulus. Methods All neonatal referrals (<29 days) to Newborn and Paediatric Emergency Transport Service between 31 July 2014 and 31 July 2020 with BV or aspirates were examined. Data on time of onset of BV, time of call for retrieval, vital signs, lactate level and blood glucose at referral, time of arrival at the surgical centre and outcome were analysed. Results Of 391 neonates referred with BV, 113 (28.9%) had a surgical cause and 31 (7.9%) had a time‐critical malrotation and/or volvulus. All 31 neonates were well at referral with normal vital signs including three neonates who subsequently died. Lactate levels at referral (1–7.5 mmol/L) were not predictive of outcome. The odds of a time‐critical diagnosis increased with every day of age (odds ratio = 1.097), heart rate >140 (P = 0.04) and decreased for each kilogram of birthweight (odds ratio 0.475; confidence interval 0.294–0.768). Conclusions Neonates with BV require urgent referral to paediatric surgery and contrast fluoroscopy. Thirteen urgent transfers are required to preserve the bowel integrity and life in one baby.

Background: Pediatric and neonatal first-pass intubation rates are higher in adult trained retrieval services than in neonatal or pediatric trained services. Some authors have attributed this to more frequent opportunities to practice the skill in the adult population. Objective:The aim of this study was to increase the first-pass intubation rate without adverse events by introducing daily intubation simulation at our mixed neonatal and pediatric retrieval service.Methods: This prospective cohort study performed from July to December 2018 in our mixed neonatal and pediatric retrieval service involved 16 medical staff performing simulated intubation at commencement of their retrieval shift with a retrieval nurse. Checklists for neonatal and pediatric intubation were introduced to the retrieval service for the intervention cohort. Participants were asked to complete questionnaires about intubation performed on retrieval to gather data not routinely collected by the service.Results: Seven hundred and sixty-eight patients were retrieved by the service and 70 patients required intubation by the retrieval team during the intervention period. First-pass intubation rates were higher during the intervention period compared with a historical cohort, despite less intubations being performed overall. First-pass intubation rates improved from 59% to 78% in neonatal patients (P = 0.032), 58% to 65% in pediatric patients (P = 0.68) and from 58% to 74% overall (P = 0.043). There were no severe adverse events detected during the intervention period. Minor adverse events were associated with multiple attempts at intubation (P < 0.001). Overall compliance with simulation protocol was 43.5%, and on average, each doctor completed simulation once per month.Conclusions: Simulation is a useful adjunct to support neonatal and pediatric intubation training in the current environment of reducing intubation frequency.

Aim To evaluate the practice of routine admission of infants at high risk of hypoglycaemia by determining the incidence of hypoglycaemia, factors that predict necessary admission and breastfeeding outcomes. Methods A retrospective cohort study of neonates admitted to a tertiary neonatal unit for high risk of hypoglycaemia. Clinical data, including blood glucose concentrations, body fat percentage and time to initiation of feeding, were collected for 122 infant–maternal dyads for a 3‐year period from April 2016 to May 2019. Descriptive statistical analysis and binary logistic regression analysis were undertaken. Results Hypoglycaemia developed in 39.3% of the neonates identified as high risk. Overall, 69 out of 122 admissions were potentially avoidable. Initial blood glucose was the most significant predictive factor for necessary admission with odds ratio of 3.26 (95% confidence interval (CI) 1.04–10.17) for an initial glucose of 1.6–2.0 and 27.05 (95% CI 5.06–144.42) for initial glucose ≤1.5. Exclusive breastfeeding rates at discharge were lower in admitted infants (59%) compared to the overall hospital rate (75.6%). Conclusions Neonates at high risk of hypoglycaemia should be monitored with their mothers as most infants needing admission are detected by initial blood glucose concentration. This would reduce infant–maternal separation and potentially improve breastfeeding rates.