Original Article

Non-Surgical Causes of Bilious Vomiting in Neonates Admitted in a Tertiary Center

Abstract

Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes. This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over two years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments, and therapeutic approaches were recorded. The mean age of neonates was 9.07±8.84 days, and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died. Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR=12.455, 95%CI: 1.365-113.618, P=0.025). The most common cause of bilious vomiting was NEC, followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation.

1. Walker GM, Raine PA. Bilious vomiting in the newborn: how often is further investigation undertaken? J Pediatr Surg 2007;42:714-6.
2. Godbole P, Stringer MD. Bilious vomiting in the newborn: How often is it pathologic? J Pediatr Surg 2002;37:909-11.
3. Kimura K, Loening-Baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician 2000;61:2791-8.
4. Kao HA. Bilious vomiting during the first week of life. Zhonghua Min Guo Xiao ErKe Yi XueHuiZaZhi 1994;35:202-7.
5. 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;140:662-4.
6. Malhotra A, Lakkundi A, Carse E. Bilious vomiting in the newborn: 6 year’s data from a Level III Centre. J Paediatr Child Health 2010;46:259-61.
7. 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;9:190-4.
8. Borooah M. Bilious vomiting in the newborn period: surgical incidence and diagnostic challenges. Arch Dis Child 2010;95:A86.
9. Fallahi G, Saneian H, Mahdizadeh M, Farahm F. Children, Gastroesophageal Reflux and Ultrasound. Acta Med Iran 2007;45:355-60.
10. Mohinuddin S, Sakhuja P, Bermundo B, Ratnavel N, Kempley S, Ward H C, et al. Outcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort. Arch Dis Child 2015;100:14-7.
11. Ameh EA, Nmadu PT. Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children. Pediatr Surg Int 2000;16:50-2.
12. Shalaby M, Kuti K, Walker G. Intestinal malrotation and volvulus in infants and children. BMJ 2013;6949:1-4.
13. Nasir AA, Abdur-Rahman LO, Adeniran JO. Outcomes of surgical treatment of malrotation in children. Afr J Paediatr Surg 2011;8:8-11.
Files
IssueVol 59, No 5 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v59i5.6666
Keywords
Neonatal Bilious vomiting Surgical Medical
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Kaveh M, Nazarirad A, Diaz D, Eshghi T, Eftekhari K. Non-Surgical Causes of Bilious Vomiting in Neonates Admitted in a Tertiary Center. Acta Med Iran. 2021;59(5):308-310.