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

The burden of excluding malrotation in term neonates with bile stained vomiting
The burden of excluding malrotation in term neonates with bile stained vomiting
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.
malrotation, neonate, volvulus, intestinal obstruction
0179-0358
1-4
Drewett, Melanie
017b4e4c-3143-40bf-bd6b-a36a8df51f3e
Johal, Nav
d81ff8b6-d89f-48b6-bcb2-7ba8b0bf74ad
Keys, Charles
ffd1498b-386e-48b5-8bfe-5ec6691a8d7c
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Burge, David
383bf4be-bbb3-427e-998e-95888bfebbc3
Drewett, Melanie
017b4e4c-3143-40bf-bd6b-a36a8df51f3e
Johal, Nav
d81ff8b6-d89f-48b6-bcb2-7ba8b0bf74ad
Keys, Charles
ffd1498b-386e-48b5-8bfe-5ec6691a8d7c
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Burge, David
383bf4be-bbb3-427e-998e-95888bfebbc3

Drewett, Melanie, Johal, Nav, Keys, Charles, Hall, Nigel J. and Burge, David (2016) The burden of excluding malrotation in term neonates with bile stained vomiting. Pediatric Surgery International, 1-4. (doi:10.1007/s00383-016-3877-2). (PMID:26895031)

Record type: Article

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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More information

Accepted/In Press date: 5 February 2016
e-pub ahead of print date: 19 February 2016
Keywords: malrotation, neonate, volvulus, intestinal obstruction
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 388619
URI: http://eprints.soton.ac.uk/id/eprint/388619
ISSN: 0179-0358
PURE UUID: c24af946-2362-4069-81ba-c2aa55e80319
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 01 Mar 2016 09:39
Last modified: 10 Dec 2019 01:38

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