Abstract
A prospective study was undertaken to evaluate the significance of isolated bilious vomiting in the first 72 hours after birth. Over a 4-year period, 45 infants (2/1000 live birth)(mean ±S.D. B.W. 3.2±0.4 kg; G.A. 39.7±1.2 wks) were admitted to NICU because of bilious vomiting without other obvious signs of GI obstruction. The extent of work-up followed a protocol which included serum electrolytes, Ca, plasma glucose, CBC and plain abd. X-ray in all cases, upper or lower GI series and septic workup if indicated.
Of the 45 infants, 9 (20%) required surgical intervention (5 malrotation, 1 jejunal atresia, 1 jejunal stenosis, 1 jejunal duplication cyst, 1 infantile myofibromatosis) and 36 (80%) associated with non-surgical conditions (31 idiopathic, 3 meconium plug; 2 left microcolon). There was no sign. diff. between the surg. and non-surg. cases at time of onset of bilious vomiting and onset of meconium passage. All infants with non-surg. condition resumed feeding by 1 week. Surgical cases had sign, higher (p<0.05) incidence of specific findings (4/9) on plain abd. X-ray than the non-surg. cases (1/36). 21/31 with idiopathic bilious vomiting had normal X-ray; 10/31 had non specific dilatation. The validity and predictive values of plain abd. X-ray were: specificity 97%, sensitivity 44%, positive predictive values 80%, negative predictive values 88%. We concluded that: 1) only 20% of infants with isolated bilious vomiting had surgical causes, 2) a positive plain abd. X-ray could predict 80% of surgical cases, a negative finding could not rule out surg. problems.
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Lilien, L., Srinivasan, G., Yeh, T. et al. 778 ISOLATED BILIOUS VOMITING IN THE FIRST 72 HRS IN TERM NEONATES. Pediatr Res 19, 240 (1985). https://doi.org/10.1203/00006450-198504000-00808
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DOI: https://doi.org/10.1203/00006450-198504000-00808