Predicting Time-Critical Pathology and Cardiorespiratory Deterioration in Infants Retrieved for Bilious Vomiting: An Observational Study

OBJECTIVE: Bilious vomiting in infants is recognized as a sign of potential surgical pathology, and these infants often require retrieval from the peripheral hospital to a surgical center for specialist investigation. We set out to show the frequency of surgical pathology, time-critical pathology, and cardiorespiratory deterioration during retrieval among infants with bilious vomiting. In addition, we aimed to show whether there is an association between the need for cardiorespiratory support at the time of referral and time-critical pathology or cardiorespiratory deterioration during the retrieval. METHODS: We completed a retrospective observational study of 104 infants younger than 44 weeks' corrected gestational age retrieved for bilious vomiting or aspirates over a 103-month period identified from the electronic retrieval record database of an Australian retrieval service. RESULTS: Of the infants included in the study, 21 (20.19%) had a surgical pathology, 6 (5.77%) had a time-critical pathology, and 10 (9.62%) experienced a cardiorespiratory deterioration during the retrieval. Infants receiving cardiorespiratory support at the time of referral were more likely to have a time-critical pathology (risk difference [RD], 24.45%; 95% confidence interval [CI], 3.23-60.07; risk ratio [RR], 6.93; 95% CI, 1.52-31.5) and more likely to experience a cardiorespiratory deterioration (RD, 50.95%; 95% CI, 18.17-78.19; RR, 9.24; 95% CI, 3.38-25.27). CONCLUSION: Our findings can help the retrieval service plan their response to referrals for infants with bilious vomiting. Awareness of the frequency of time-critical pathology and of deterioration during retrieval and the increased risk of both among those requiring cardiorespiratory support at the time of referral could inform the timing of response and team composition.