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

Drewett, Melanie; Johal, Navroop; Keys, Charles; Hall, Nigel; Burge, D.M.

doi:10.1007/s00383-016-3877-2

Cited by 21 publications

(25 citation statements)

References 13 publications

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“…This may be because we excluded the cases of antenatally detected pathologies but could also be an indication of an increasing likelihood of paediatricians/neonatologists referring cases of bilious vomiting due to the increased awareness of the risks. This is supported by the report from Drewett et al 2 who also found an increase in referrals to their centre without an increase in the detection of malrotaion.…”

Section: Discussionsupporting

confidence: 61%

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

Ojha

Sand

Ratnavel

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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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.

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Section: Discussionsupporting

confidence: 61%

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

Ojha

Sand

Ratnavel

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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“…Only two infants in our cohort were diagnosed with malrotation, both presenting after 24 hours, which is consistent with other reports in the literature. [7]. Our ndings demonstrated that infants with surgical pathology were more likely to present later.…”

Section: Discussionmentioning

confidence: 61%

“…30% of neonates with malrotation present within 3-7 days, and 80% by 1 month, indicating that many cases will present after discharge from hospital. [7]. One study reported that 15% of term infants less than 7 days old transferred by the London Neonatal Transport Service were for BV.…”

Section: Introductionmentioning

confidence: 99%

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Low incidence of surgical pathology in infants with bilious vomiting

Cummins

Kuschel

2021

Preprint

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Background: Bilious vomiting in the neonate is an important presenting sign of intestinal obstruction. We conducted a review of the presentation and management of term neonates admitted with bilious vomiting (BV) to determine the incidence of a surgical pathology in our population.  Design: Retrospective cohort study using a prospectively maintained database.  Participants: All term infants admitted to NICU with BV at the Royal Women’s Hospital Melbourne during a 5-calendar year period.  Results: All 153 babies had at least one imaging study. 128 (83.7%) had plain abdominal radiographs. 127 (83%) underwent upper gastrointestinal contrast scan (UGI) and 103 (67.3%) had both. 6 (3.9%) UGI studies were abnormal, with 3 babies (1.9%) subsequently having surgical pathology (2 volvulus, 1 Hirschsprung disease). Only 6 (3.9%) babies in our cohort had a surgical pathology identified (4 Hirschsprung disease, 2 malrotation). Babies with surgical pathology were more likely to present later (median 40 hours versus 23 hours). Abdominal distension was highly sensitive for surgical pathology.  Conclusion: The incidence of surgical pathology in this cohort was low compared to other studies. It is more likely in infants presenting with BV after 24 hours.

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“…This wide range of abnormalities leads to various acute and chronic presentations of the disease (1,2). Since this disease is often associated with acute symptoms such as acute midgut volvulus, catastrophic risk of ischemia, and midgut gangrene, it must be considered as a serious surgical emergency and must be immediately diagnosed and the patients should undergo surgery prior to development of midgut gangrene (3).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Ultrasound and Gastrointestinal Series Findings in Detection of Pediatric Intestinal Malrotation

2018

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Background: Clinical diagnosis of malrotation is difficult to achieve, especially in older children and adults as its nonspecific presentations at this stage are usually neglected leading to delayed diagnosis of these cases. Objectives: In this study, we aimed to evaluate the diagnostic values of ultrasound and upper gastrointestinal (GI) series in patients with suspected intestinal malrotation. Methods: This six-year cross-sectional, prospective study was conducted in Dr. Sheikh Children's Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2015. Totally, 67 children (aged < 15 years) with clinical findings of intestinal malrotation who had evidence of malrotation in ultrasound or upper GI series were enrolled in the study. Results of radiological evaluation were compared to the final diagnosis of patients achieved from surgery. Data analysis was performed using SPSS software. Results: Of the 67 enrolled participants with clinical findings or suspected radiological signs of intestinal malrotation, about half (52.2%) were male. Patients were 2 days to 16 years (mean, 2.5 years) old. Associated anomalies were observed in 47.7% of cases. Sensitivity and specificity were 82.5% and 85.7%, respectively for GI series findings and 82.3% and 54.5%, respectively for ultrasound compared with surgical findings as a gold standard. Conclusions: Ultrasound has a similar diagnostic value compared to upper GI series. They are complementary examinations and negative ultrasound or GI series results do not necessarily rule out intestinal malrotation. Mesenteric vessels ultrasound could be used as an accurate diagnostic method for the detection of intestinal rotational disorders.

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

Cited by 21 publications

References 13 publications

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

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

Low incidence of surgical pathology in infants with bilious vomiting

Diagnostic Value of Ultrasound and Gastrointestinal Series Findings in Detection of Pediatric Intestinal Malrotation

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