Perinatology.  2016 Dec;27(4):216-221. 10.14734/PN.2016.27.4.216.

Risk Factors of Operation in Neonates with No Less Than 35 Weeks of Gestational Age with Bilious Vomiting

• Shin JS
• Lee YH
• Shim GH
• Chey MJ

• KMID: 2367032
• DOI: http://doi.org/10.14734/PN.2016.27.4.216

Abstract

PURPOSE
Bilious vomiting in neonates is an urgent condition that frequently requires neonatal surgical involvement. We aimed to describe the prevalence of surgical intervention and compare clinical characteristics between neonates with and without operation.
METHODS
The medical records and images were reviewed for neonates with no less than 35 weeks of gestational age who have a bilious vomiting and admitted to the neonatal intensive care unit (NICU) at Inje University Sanggye Paik Hospital from January 2010 to December 2015.
RESULTS
Fifty neonates with bilious vomiting were analyzed whose were admitted to our NICU and not transferred during the period. Twenty-one (42%) neonates had laparotomies of which 9 were malrotations with volvulus, 6 Hirschsprung's disease, 2 duodenal atresia or stenosis, 2 small bowel obstructions, 1 neonatal necrotizing enterocolitis, and 1 meconium ileus. Gestational age was 39⁺² weeks (35⁺⁰-40⁺⁶ weeks); birth weight was 3,120 g (1,885-4,650 g). There were 24 (48%) abnormal X-rays, 25 (50%) abnormal abdominal sonographies and/or contrast studies. Univariate analysis indicate that frequency of vomitus, volume of vomitus, abdominal distension, delayed passage of meconium, neonatal cholestasis, abnormal X-rays, abnormal abdominal sonographies or contrast studies were significant predictors of operation. Multivariate analysis showed that frequency of vomitus (P=0.002, odds ratio [OR] 5.7, 95% confidence interval [CI] 1.9-17.1) and abnormal abdominal sonographies or contrast studies (P=0.007, OR 22.2, 95% CI 2.3-212.1) were independent risk factors for operation.
CONCLUSION
Frequency of vomitus and abnormal abdominal sonographies or contrast studies in neonates with bilious vomiting may be the most important indicator to predict the need for surgery

Keyword

Bile; Vomiting; Neonate; Surgery

MeSH Terms

Bile
Birth Weight
Cholestasis
Constriction, Pathologic
Enterocolitis, Necrotizing
Gestational Age*
Hirschsprung Disease
Humans
Ileus
Infant, Newborn*
Intensive Care, Neonatal
Intestinal Volvulus
Laparotomy
Meconium
Medical Records
Multivariate Analysis
Odds Ratio
Prevalence
Risk Factors*
Vomiting*

Reference

1. Shalaby MS, Kuti K, Walker G. Intestinal malrotation and volvulus in infants and children. BMJ. 2013; 347:f6949.

2. Kimura K, Loening-Baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician. 2000; 61:2791–2798.

3. Walker GM, Raine PA. Bilious vomiting in the newborn: how often is further investigation undertaken? J Pediatr Surg. 2007; 42:714–716.

4. Hernanz-Schulman M. Imaging of neonatal gastrointestinal obstruction. Radiol Clin North Am. 1999; 37:1163–1186.

5. Godbole P, Stringer MD. Bilious vomiting in the newborn: How often is it pathologic? J Pediatr Surg. 2002; 37:909–911.

6. Mohinuddin S, Sakhuja P, Bermundo B, Ratnavel N, Kempley S, Ward HC, et al. Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort. Arch Dis Child. 2015; 100:14–17.

7. Neuhauser EB, Berenberg W. Cardioesophageal relaxation as cause of vomiting in infants. Radiol. 1947; 48:480–483.

8. Patterson M, Rintala P, Lloyd DA. A longitudinal study of electrogastrography in normal neonates. J Pediatr Surg. 2000; 35:59–61.

9. Lilien LD, Srinivasan G, Pyati SP, Yeh TF, Pildes RS. Green vomiting in the first 72 hours in normal infants. Am J Dis Child. 1986; 140:662–664.

10. Kao HA. Bilious vomiting during the first week of life. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1994; 35:202–207.

11. Malhotra A, Lakkundi A, Carse E. Bilious vomiting in the newborn: 6 years data from a Level III Centre. J Paediatr Child Health. 2010; 46:259–261.

12. Alehossein M, Abdi S, Pourgholami M, Naseri M, Salamati P. Diagnostic accuracy of ultrasound in determining the cause of bilious vomiting in neonates. Iran J Radiol. 2012; 9:190–194.

13. Sokal MM, Koenigsberger MR, Rose JS, Berdon WE, Santulli TV. Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med. 1972; 286:823–825.

14. Cooney DR, Rosevear W, Grosfeld JL. Maternal and postnatal hypermagnesemia and the meconium plug syndrome. J Pediatr Surg. 1976; 11:167–172.

15. Cowett RM. The infant of the diabetic mother. Neoreviews. 2002; 3:e173–e189.