133 Evaluating the success of a management pathway for neonatal referrals with bilious vomiting. (December 2018)

• Record Type: Journal Article
• Authors: Jones, R; Hannam, Simon
• Is Part Of: Archives of disease in childhood. Volume 103(2018)Supplement 2
• Page Start: A54
• Page End: A54
• Publication Date: 2018-12
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/goshabs.133
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : This retrospective service evaluation was undertaken to evaluate the success of a management pathway introduced for neonatal referrals with bilious vomit into Great Ormond Street Hospital. In the literature, between 26%–70% of neonates who present with bilious vomit have a surgical diagnosis, and of these, 9%–17% had a diagnosis of malrotation, (Drewett et al, 2016; Verma et al, 2016). It is deemed by surgeons to be a time-critical emergency with delays in management having the potential to lead to catastrophic consequences. With local trust audit approval, all neonatal admissions referred with bilious vomit over a 20 month period (February 2015 – September 2016) were included in a retrospective service evaluation. Quantitative data were collected from Intensive Care admission logs and electronic patient records. Time from referral to admission, admission to contrast and contrast to theatre was collated, as well as patient and transport demographics, diagnosis and outcomes. 92 neonates meet the inclusion criteria. 98% followed the pathway with 28% being diagnosed with a surgical condition and 13% diagnosed with malrotation. 85% were admitted within 4 hours of referral. 14 neonates had alternative diagnoses on admission and left the pathway. Of the 74 neonates who underwent an upper gastrointestinal contrast study, 60.8% had their study done within 2 hours of arrival. Time to theatre from diagnosis ranged 74–397 min (with a mean of 181.8 min). There were no deaths and only one patient required resection and subsequent diagnosis of short gut. In conclusion, neonates with bilious vomit should be considered a surgical emergency with 28% of our referrals requiring surgical intervention and half of that number having a time critical diagnosis. The data analysis showed no significant failures in the management of these neonates and the implementation of a specific pathway has resulted in an impressive referral to treatment times.