{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:02:15Z","timestamp":1789448535582,"version":"build-2803163510"},"reference-count":8,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bilious vomiting or aspirates (BVA) in the neonatal period may herald malrotation and\/or life\u2010threatening volvulus. In New South Wales (NSW), contrast fluoroscopy is not available for neonates in most non\u2010tertiary paediatric centres and transfer is required. The previous study in 2020 showed that 13 retrievals were required to identify one case of time\u2010critical malrotation\/volvulus and that improvements could be made in the recognition and referral of neonates with BVA. A statewide consensus clinical pathway was developed and a working group carried out training and education sessions to increase awareness of time\u2010critical transfer to surgical centres. The aim of this study was to evaluate the impact of the pathway on the frequency of retrievals and the identification of malrotation\/volvulus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Neonatal referrals (\u2264\u200928\u2009days) to NETS NSW between 1 August 2020 and 1 August 2023 with BVA were examined. BVA retrievals between 31 July 2014 and 31 July 2020 acted as a historical control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 37 (12\/year) cases of malrotation\/volvulus among 622 retrievals in the 3\u2010year study period. This was in comparison to 31 (5\/year) cases among 391 retrievals in the 6\u2010year historical control. This equates to 3.1\u2010fold increase in BVA retrievals (207\/year vs. 65\/year), but with similar incidence of malrotation and\/or volvulus (6% vs. 8%, respectively, mean risk difference, \u22121.98%, 95% CI: \u22125.24, 1.28). The number of retrievals required to identify one case of malrotation\/volvulus increased modestly from 13 to 17.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The modified clinical pathway resulted in a threefold increase in BVA retrievals and a twofold increase in the number of life\u2010threatening malrotation\/volvulus cases identified per year. No deaths were observed during the study period. Retrieval times were similar between epochs, indicating the pathway's effect on case ascertainment statewide.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70582","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:05:58Z","timestamp":1789445158000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Should the Neonatal Retrieval Team Respond to the Neonate Referred With Bilious Vomiting: Mark\n                    <scp>II<\/scp>"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-1273","authenticated-orcid":false,"given":"S.","family":"Nundeekasen","sequence":"first","affiliation":[{"name":"Newborn and Paediatric Emergency Transport Service  Sydney Australia"},{"name":"The Canberra Hospital Neonatal Intensive Care Unit  Canberra Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1458-5551","authenticated-orcid":false,"given":"H.","family":"Dalrymple","sequence":"additional","affiliation":[{"name":"Grace Centre for Newborn Intensive Care  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7754-6296","authenticated-orcid":false,"given":"A.","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Newborn and Paediatric Emergency Transport Service  Sydney Australia"},{"name":"Grace Centre for Newborn Intensive Care  Sydney Australia"},{"name":"University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8416-0279","authenticated-orcid":false,"given":"G.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Grace Centre for Newborn Intensive Care  Sydney Australia"},{"name":"University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Lakkundi","sequence":"additional","affiliation":[{"name":"John Hunter Neonatal Intensive Care Unit  Newcastle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3683-6569","authenticated-orcid":false,"given":"S.","family":"Bolisetty","sequence":"additional","affiliation":[{"name":"Royal Hospital for Women Neonatal Intensive Care Unit  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1200-9016","authenticated-orcid":false,"given":"K.","family":"Browning Carmo","sequence":"additional","affiliation":[{"name":"Newborn and Paediatric Emergency Transport Service  Sydney Australia"},{"name":"Grace Centre for Newborn Intensive Care  Sydney Australia"},{"name":"University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.15829"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.07.007"},{"key":"e_1_2_11_4_1","unstructured":"Newborn & Paediatric Emergency Transport Service www.nets.org.au."},{"issue":"2","key":"e_1_2_11_5_1","first-page":"A168","article-title":"908\u2009Can the Colour of Vomitus Predict the Outcomes of Infants Transferred With Bilious Vomiting?","volume":"108","author":"Fullerton L.","year":"2023","journal-title":"Archives of Disease in Childhood"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.13739"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2023-326415"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/pxaf042"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1558460"}],"container-title":["Journal of Paediatrics and Child 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