[size=6]You receive a call from a referring neonatologist regarding a full term newborn with bilious emesis and an abnormal abdominal radiograph. She would like advice about doing further diagnostic studies at her institution. You suggest immediate transfer as the incidence of surgical pathology in term neonates transferred for bilious vomiting is approximately

 

a 26 to 50%.

 

b 51 to 75%.

 

c greater than 75%.

 

d zero to 25%.[/size]

D

C

C

correct answer

a 26 to 50%.

 

Mohinudin reviewed 163 neonates over a four year period who were transferred to a regional center. They found that 46% had a surgical diagnosis and 14.1% required an emergent operation. An abnormal plain film of the abdomen was considered to be important with a sensitivity of 97%.

 

In a more recent paper by Nundeekasen et al. of 391 neonatal referrals in New South Wales for Bilious vomiting (BV) 28.9% had surgical pathology almost 8% with the time critical diagnosis of malrotation. The authors concluded that in neonates with BV, urgent transfers are still encouraged with thirteen transfers required to preserve the bowel/life of a single neonate.

[size=6]You receive a call from a referring neonatologist regarding a full term newborn with bilious emesis and an abnormal abdominal radiograph. She would like advice about doing further diagnostic studies at her institution. You suggest immediate transfer as the incidence of surgical pathology in term neonates transferred for bilious vomiting is approximately

 

a 26 to 50%.

 

b 51 to 75%.

 

c greater than 75%.

 

d zero to 25%.[/size]

B

A

A

Studies of referred or transferred neonates have reported surgical diagnoses in 46%of cases. Causes include intestinal atresia, malrotation with or without volvulus, and Hirschsprung disease. Urgent assessment is necessary because volvulus can rapidly compromise intestinal blood supply.