Bile vomiting in paediatrics: what do we really know?

Abstract

Bile vomiting is clinically significant in neonates and children, indicating intestinal obstruction until proven otherwise. The aim of this study was to assess whether nursing staff within a children's hospital were able to accurately identify bilious vomiting and if a deficiency existed, whether educational posters could rectify this problem. A primary audit was conducted in the Royal Aberdeen Children's Hospital evaluating the ability of nursing staff to identify bile vomit and its significance. Educational posters were distributed and a secondary audit was conducted after six months to complete the audit cycle. The second audit also compared the knowledge of different medical professionals. In the primary audit, 41% of nurses selected the colour yellow, compared with 18% of nurses in the second audit with approximately 70% selecting dark-green. Thirty-three percent of nurses in the primary audit confirmed intestinal obstruction as the cause of bile vomiting, compared with 64% of nurses in the secondary audit. In conclusion, this study identified a deficiency in the recognition of bile vomiting among nurses, but demonstrates that the use of educational posters can significantly improve knowledge. This can be beneficial in the early recognition of this potential surgical emergency.

Dilemmas Surrounding Interpretation of Gastric Residuals in the NICU Setting

“…Researchers, using simulated gastric output depicting various shades of yellow and green, have demonstrated variability among health care providers in identifying which shades of color represent a bilious gastric output. [76][77][78][79] In the study by Cormack et al, 76 participants were asked to identify the residual color significant enough to withhold a feeding. There was substantial variation in the residual color that would result in feedings withheld.…”